[Changes in left ventricular function with effort in the coronary patient. l]

Abstract

The altered haemodynamics of the coronary patient have been investigated in 30 patients both at rest and under conditions of maximal effort as carried out on the bicycle ergometer under the usual conditions for an exercise electrocardiogram. Patients with angina of effort but no previous infarction have normal left ventricular function at rest; under the ischaemia induced by exercise there is acute dysfunction of the left ventricle as witnessed by a reduction in maximal cardiac output, a raised end-diastolic pressure, and changes in compliance which are more marked than those in contractility. Patients with a healed infarct but without sequelae have a rigid left ventricle, but it is not failing; they show normal changes in dP/dt max and in the indices of left ventricular work, but a pathological form of negative peak of dP/dt, of end-diastolic pressure, and of deltaP/deltaV (which reflects myocardial compliance). Patients who have had an infarction with sequelae such as angina or attacks of left ventricular failure have filling pressures which are already elevated at rest, and cardiac failure, which becomes evident on exercise.