Left ventricular function during isometric exercise (handgrip): significance of an atrial gallop (S 4)

• Published in: The American heart journal Vol. 88; no. 6; pp. 686 - 693
• Main Authors: Matthews, Oscar A, Blomqvist, C.Gunnar, Cohen, Lawrence S, Mullins, Charles B
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.12.1974
• Subjects: Adult; Arm - blood supply; Atrial Function; Blood Pressure; Cardiac Output; Electrocardiography; Evaluation Studies as Topic; Exercise Test; Female; Heart Auscultation; Heart Rate; Humans; Male; Middle Aged; Phonocardiography; Physical Exertion; Space life sciences; Vascular Resistance; Ventricular Function
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/0002-8703(74)90276-2

The clinical significance of an atrial (S 4) gallop remains controversial. The present study was undertaken to investigate whether the development of an atrial gallop (S 4) during stress correlated more closely with an abnormal left ventricular function than the presence of an S 4 at rest. Left ventricular function was assessed by relating changes in SWI to left ventricular enddiastolic pressure during isometric exercise at 25 per cent and 50 per cent of a maximum voluntary handgrip contraction. A phonocardiogram was recorded continuously during the procedure. Six patients with no S 4 at rest or during isometric exercise all had normal ventricular function curves. Six patients had no atrial gallop at rest but developed an S 4 during isometric exercise. In this group, all but one patient had an abnormal left ventricular function curve. Finally, nine patients had an S 4 at rest as well as during isometric exercise. Seven of these patients had a normal left ventricular function curve. The results suggest that the development of an atrial gallop during isometric stress may be a more reliable indicator of left ventricular dysfunction than the presence of an S 4 at rest. Therefore, isometric exercise can be employed as a bedside procedure for evaluation of left ventricular function.