The detection of abnormal left ventricular function is important for the diagnosis and prognosis in many cardiac diseases. In the early stage of primary cardiomyopathy or coronary artery disease, left ventricular performance may be normal at rest and only becomes abnormal during stress. Various types of stress have been used in the clinical evaluation of patients with suspected or overt cardiac disease. Pharmacologically applied, stress has been popular in the cardiac catheterization laboratory because no patient cooperation is required and the agents can be administered intravenously in this setting. Angiotensin or phenylephrine have been used to increase systemic arterial pressure and, thus, elevate after-load. Normal ventricles when faced with increased after-load stress will show reduced left ventricular performance and in an abnormal ventricle this can result in a decrease in function to below normal levels. Elevating the heart rate also results in increased stress to the left ventricle. This has been done in the cardiac catheterization laboratory by the use of intravenous isoproterenol, atropine or by transvenous intracardiac pacing. These techniques may lead to abnormalities of left ventricular function, especially if the patient has ischemic heart disease or hypertrophic cardiomyopathy. Pharmacologic stress and pacing have also been used in echocardiographic studies, but these techniques have found little use outside the cardiac catheterization laboratory because of the necessity of intravenous injections and careful monitoring of the patient .
KeywordsWall Motion Abnormality Radionuclide Angiography Left Ventricular Performance Handgrip Exercise Cardiac Catheterization Laboratory
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