Diastolic Heart Sounds during Static (Handgrip) Exercise

In order to determine the frequency of third and fourth heart sounds during cardiovascular stress, 61 patients with chest pain syndromes and normal resting phonocardiograms underwent phonocardiography both before and during submaximal handgrip exercise. Cardiac catheterization, selective coronary arteriography, and left ventriculography were performed in all patients. Twenty-nine had phonocardiograms simultaneous with hemodynamic studies. Twenty patients had normal coronary arteriograms; 41 had obstructive coronary artery disease. Fifteen percent of the subjects with normal coronary arteriograms and 54% of the patients with coronary artery dis-