Onset of Angina Pectoris in Relation to Circulatory Adaptation during Arm and Leg Exercise

Abstract

The circulatory adaptation to arm and leg exercise was studied with stepwise increased work loads in 10 patients with signs of coronary artery disease. Both arm and leg exercise elicited angina pectoris in all patients. Anginal pain appeared at the same level of pressure-time per minute (PTM) in the two forms of exercise, but at a smaller work load and a lower pulmonary oxygen uptake during arm exercise than during leg exercise. Heart rate, PTM, and peak systolic, systolic mean, diastolic, and mean arterial pressures all increased more steeply in relation to work load during arm exercise than during leg exercise. The differences in circulatory adaptation during arm and leg exercise are attributed in part to a lower mechanical efficiency and a higher sympathetic outflow during arm exercise. These factors may in turn reflect the involvement of smaller muscle groups and a larger component of static work with trunk muscles during arm exercise. The pattern of response to exercise resembles that seen in healthy subjects and provides a pathophysiologic background for the earlier appearance of anginal symptoms during arm than leg exercise in patients with coronary artery disease.