The Response of the Abnormal Heart to Exercise

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Abstract
Hemodynamic studies at rest and during exercise were made in 24 patients with nonvalvular heart disease utilizing cardiac catheterization. The observations were secured in patients with left ventricular failure, combined ventricular failure, and in those who had recovered from failure or who had never been in failure. A wide variety of response to exercise was found. The most abnormal was seen in patients with combined ventricular failure in whom blood flow was either fixed or greatly diminished and lesser circulation pressures were augmented. The performance of patients in left ventricular failure was different from those in combined failure in that, despite augmentation of lesser circuit pressures, blood flow increased surprisingly well although not always to a normal degree. Patients without clinical evidence of congestive failure displayed a wide variety of hemodynamic response on exercise, ranging from normal to grossly abnormal. A spectrum of ventricular behavior was confirmed. The least abnormal pattern that was found consisted of a normal response in blood flow accompanied by an abnormal rise in pressures in the lesser circulation on effort. This performance was ascribed to a hypertrophied heart. When both blood flow and pressures were grossly abnormal, it was postulated that ventricular dilatation existed. The presence of atrial fibrillation, even in the absence of congestive failure, was found to compromise blood flow during exercise.

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