SUMMARY OF CURRENT THERAPY: The Exercise Apexcardiogram in Angina Pectoris: Its Possible Usefulness in Diagnosis and Therapy

Abstract

S EPARATE WORKERS UTILIZING SEVERAL instrumental approaches have studied precordial vibrations1 and have identified various alterations in patients with angina pectoris. We have studied particularly the low frequency (0.1 to 20 cycles per second) displacement vibrations at the apex : the apexcardiogram. In ischemic heart disease and especially after effort, we have noted almost uniformly ( 70 of 76 patients), the occurrence of a large vibration due to atrial thrust at the apex.4 By simultaneous recording of the left ventricular pressure curve and the apexcardiogram, we have documented that this large atrial component of the apexcardiogram is directly reflecting a rise in the enddiastolic left ventricular pressure. In data obtained at rest, after exercise, before and after nitroglycerin, before and after venous tourniquets, we have found a proportional relationship between the amplitude of the atrial component and the degree of elevation of end-diastolic left ventricular pressure.2 Other investigators have confirmed the rise in end-diastolic left ventricular pressure in the presence of angina pectoris.” From these experiences we make the following suggestions: 1. In patients with angina pectoris, there is, either at rest or upon exercise, dependent upon the severity of the ischemic heart disease, a rise in end-diastolic left ventricular pressure. We are referring particularly