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Cardiovascular Responses to Isometric Exercise in Patients With Mitral Stenosis: Comparison With Normal Subjects and Patients With Depressed Ejection Fraction

Cardiovascular Responses to Isometric Exercise in Patients With Mitral Stenosis: Comparison With... Abstract • The hemodynamic response to isometric handgrip was evaluated in 15 patients with mitral stenosis (MS), 12 normal subjects, and 13 patients with severe left ventricular failure (LVF). Acceleration of heart rate and rise in left ventricular systolic pressure were not significantly different between the three groups. Left ventricular end-diastolic pressure did not change in normal subjects and patients with MS during handgrip, but it was raised markedly in patients with LVF. Cardiac index increased in normal subjects but did not change in patients with MS and LVF. Stroke index declined in patients with LVF. In all groups there was a modest and similar increase in oxygen consumption and significant widening of the arteriovenous oxygen difference in patients with LVF. In patients with MS, pulmonary capillary pressure increased by an average of 10.6 mm Hg, with a parallel rise in mean pulmonary artery pressure and no change in pulmonary vascular resistance. It is concluded that patients with MS demonstrate a normal chronotropic and pressor response to isometric exercise. Normal left ventricular end-diastolic pressure response to isometric handgrip stress in patients with MS suggests good left ventricular performance. (Arch Intern Med 1982;142:1629-1633) References 1. Donald KW, Bishop JM, Wade OL, et al: Cardio-respiratory function two years after mitral valvotomy. Clin Sci 1957;16:325-350. 2. Chapman CB, Mitchell JH, Sproule BJ, et al: The maximal oxygen intake test in patients with predominant mitral stenosis: A preoperative and postoperative study. Circulation 1960;22:4-13.Crossref 3. Bishop JM, Wade OL: Relations between cardiac output and rhythm, pulmonary vascular pressures and disability in mitral stenosis. Clin Sci 1963;24:391-404. 4. Feigenbaum H, Campbell RW, Wunsch CM, et al: Evaluation of the left ventricle in patients with mitral stenosis. Circulation 1966;34:462-472.Crossref 5. Ross J Jr, Gault JH, Mason DT, et al: Left ventricular performance during muscular exercise in patients with and without cardiac dysfunction. Circulation 1966;34:597-608.Crossref 6. Blackmon JR, Rowell LB, Kennedy JW, et al: Physiological significance of maximal oxygen intake in `pure' mitral stenosis. Circulation 1967;36:497-510.Crossref 7. Fisher ML, Nutter DO, Jacobs W, et al: Haemodynamic responses to isometric exercise (handgrip) in patients with heart disease. Br Heart J 1973;35:422-432.Crossref 8. Grossman W, McLaurin LP, Saltz SB, et al: Changes in the inotropic state of the left ventricle during isometric exercise. Br Heart J 1973;35:697-704.Crossref 9. Horwitz LD, Mullins CB, Payne RM, et al: Left ventricular function in mitral stenosis. Chest 1973;64:609-614.Crossref 10. Cohn LH, Mason DT, Ross J Jr, et al: Preoperative assessment of aortic regurgitation in patients with mitral valve disease. Am J Cardiol 1967;19:177-182.Crossref 11. Flessas AP, Connelly GP, Handa S, et al: Effects of isometric exercise on the end-diastolic pressure, volumes and function of the left ventricle in man. Circulation 1976;53:839-847.Crossref 12. Lind AR, Taylor SH, Humphreys PW, et al: The circulatory effects of sustained voluntary muscle contraction. Clin Sci 1964;27:229-244. 13. Mitchell JH, Wildenthal K: Static (isometric) exercise and the heart: Physiological and clinical considerations. Ann Rev Med 1974;25:369-381.Crossref 14. Arani DT, Carleton RA: The deleterious role of tachycardia in mitral stenosis. Circulation 1967;36:511-516.Crossref 15. Ludbrook P, Karliner JS, O'Rourke RA: Effects of submaximal isometric handgrip on left ventricular size and wall motion. Am J Cardiol 1974;33:30-36.Crossref 16. Stefadouros MA, Grossman W, Shahawy ME, et al: The effect of isometric exercise on the left ventricular volume in normal man. Circulation 1974;49:1185-1189.Crossref 17. Crawford MH, White DH, Amon KW: Echocardiographic evaluation of the left ventricular size and performance during handgrip and supine and upright bicycle exercise. Circulation 1979;59:1188-1196.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Cardiovascular Responses to Isometric Exercise in Patients With Mitral Stenosis: Comparison With Normal Subjects and Patients With Depressed Ejection Fraction

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340220043009
Publisher site
See Article on Publisher Site

Abstract

Abstract • The hemodynamic response to isometric handgrip was evaluated in 15 patients with mitral stenosis (MS), 12 normal subjects, and 13 patients with severe left ventricular failure (LVF). Acceleration of heart rate and rise in left ventricular systolic pressure were not significantly different between the three groups. Left ventricular end-diastolic pressure did not change in normal subjects and patients with MS during handgrip, but it was raised markedly in patients with LVF. Cardiac index increased in normal subjects but did not change in patients with MS and LVF. Stroke index declined in patients with LVF. In all groups there was a modest and similar increase in oxygen consumption and significant widening of the arteriovenous oxygen difference in patients with LVF. In patients with MS, pulmonary capillary pressure increased by an average of 10.6 mm Hg, with a parallel rise in mean pulmonary artery pressure and no change in pulmonary vascular resistance. It is concluded that patients with MS demonstrate a normal chronotropic and pressor response to isometric exercise. Normal left ventricular end-diastolic pressure response to isometric handgrip stress in patients with MS suggests good left ventricular performance. (Arch Intern Med 1982;142:1629-1633) References 1. Donald KW, Bishop JM, Wade OL, et al: Cardio-respiratory function two years after mitral valvotomy. Clin Sci 1957;16:325-350. 2. Chapman CB, Mitchell JH, Sproule BJ, et al: The maximal oxygen intake test in patients with predominant mitral stenosis: A preoperative and postoperative study. Circulation 1960;22:4-13.Crossref 3. Bishop JM, Wade OL: Relations between cardiac output and rhythm, pulmonary vascular pressures and disability in mitral stenosis. Clin Sci 1963;24:391-404. 4. Feigenbaum H, Campbell RW, Wunsch CM, et al: Evaluation of the left ventricle in patients with mitral stenosis. Circulation 1966;34:462-472.Crossref 5. Ross J Jr, Gault JH, Mason DT, et al: Left ventricular performance during muscular exercise in patients with and without cardiac dysfunction. Circulation 1966;34:597-608.Crossref 6. Blackmon JR, Rowell LB, Kennedy JW, et al: Physiological significance of maximal oxygen intake in `pure' mitral stenosis. Circulation 1967;36:497-510.Crossref 7. Fisher ML, Nutter DO, Jacobs W, et al: Haemodynamic responses to isometric exercise (handgrip) in patients with heart disease. Br Heart J 1973;35:422-432.Crossref 8. Grossman W, McLaurin LP, Saltz SB, et al: Changes in the inotropic state of the left ventricle during isometric exercise. Br Heart J 1973;35:697-704.Crossref 9. Horwitz LD, Mullins CB, Payne RM, et al: Left ventricular function in mitral stenosis. Chest 1973;64:609-614.Crossref 10. Cohn LH, Mason DT, Ross J Jr, et al: Preoperative assessment of aortic regurgitation in patients with mitral valve disease. Am J Cardiol 1967;19:177-182.Crossref 11. Flessas AP, Connelly GP, Handa S, et al: Effects of isometric exercise on the end-diastolic pressure, volumes and function of the left ventricle in man. Circulation 1976;53:839-847.Crossref 12. Lind AR, Taylor SH, Humphreys PW, et al: The circulatory effects of sustained voluntary muscle contraction. Clin Sci 1964;27:229-244. 13. Mitchell JH, Wildenthal K: Static (isometric) exercise and the heart: Physiological and clinical considerations. Ann Rev Med 1974;25:369-381.Crossref 14. Arani DT, Carleton RA: The deleterious role of tachycardia in mitral stenosis. Circulation 1967;36:511-516.Crossref 15. Ludbrook P, Karliner JS, O'Rourke RA: Effects of submaximal isometric handgrip on left ventricular size and wall motion. Am J Cardiol 1974;33:30-36.Crossref 16. Stefadouros MA, Grossman W, Shahawy ME, et al: The effect of isometric exercise on the left ventricular volume in normal man. Circulation 1974;49:1185-1189.Crossref 17. Crawford MH, White DH, Amon KW: Echocardiographic evaluation of the left ventricular size and performance during handgrip and supine and upright bicycle exercise. Circulation 1979;59:1188-1196.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Sep 1, 1982

References