Diastolic heart sounds during static (handgrip) exercise in patients with chest pain.

Abstract

In order to determine the frequency of third and fourth heart sounds during cardiovascular stress, 61 patients with chest pain syndromes and normal resting phonocardiograms underwent phonocardiography both before and during submaximal handgrip exercise. Cardiac catheterization, selective coronary arteriography, and left ventriculography were performed in all patients. Twenty-nine had phonocardiograms simultaneous with hemodynamic studies. Twenty patients had normal coronary arteriograms; 41 had obstructive coronary artery disease. Fifteen percent of the subjects with normal coronary arteriograms and 54% of the patients with coronary artery disease developed diastolic heart sounds after handgrip exercise ( P < 0.05). Conversely, 88% of the patients developing a diastolic heart sound had coronary artery disease. (If data from the present study are taken together with the previously reported prevalence of diastolic heart sounds at rest, it is estimated that these sounds can be readily demonstrated in approximately 75% of patients with coronary artery disease). Subjects with normal coronary arteriograms who developed postexercise diastolic heart sounds had a greater elevation in LVEDP and a lower EDVI/EDP ratio than did patients without these sounds, although the differences were not statistically significant. However, patients with coronary artery disease who developed abnormal heart sounds had changes which were significantly different from those who did not ( P < 0.001 and P < 0.05, respectively). These findings suggest that (1) the emergence of diastolic heart sounds during handgrip exercise is a useful clinical adjunct in the diagnosis of coronary artery disease and (2) in patients with coronary artery disease, these sounds are associated with significant elevations in LVEDP, which in turn may be related to altered end-diastolic volume-pressure relationships.