The clinical significance of an atrial (S4) gallop remains controversial. The present study was undertaken to investigate whether the development of an atrial gallop (S4) during stress correlated more closely with an abnormal left ventricular function than the presence of an S4 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 S4 at rest or during isometric exercise all had normal ventricular function curves. Six patients had no atrial gallop at rest but developed an S4 during isometric exercise. In this group, all but one patient had an abnormal left ventricular function curve. Finally, nine patients had an S4 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 S4 at rest. Therefore, isometric exercise can be employed as a bedside procedure for evaluation of left ventricular function.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine