Bygdeman S: Onset of angina pectoris in relation to circulatory adaptation during arm and leg exercise. Circulation 44: 432

The circulatory adaptation to arm and leg exercise was studied with stepwise in-creased 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 involve-ment 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 appear-ance of anginal symptoms during arm than leg exercise in patients with coronary artery disease. Additional Indexing Words: Arm exercise Coronary heart disease Pressure-time per minute Static work Sympathetic tone Mechanical efficiency IT IS A COMMON clinical experience that patients with angina pectoris and limited exercise tolerance may precipitate their symp-toms readily with light arm work, yet be able to perform heavier exercise with the legs without symptoms. The reason for this dis-crepancy is still not fully understood. How-ever, in healthy subjects, different hemody-namic and ventilatory responses have been found for exercise with small and large muscle groups. During exercise with the arms pulmo