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SUMMARY The feasibility of using the cold pressor test and the sustained isometric handgrip test as alternatives to dynamic exercise for stressing the heart was investigated. Serial changes in heart rate, blood pressure, and left ventricular performance induced by these tests were studied by radionuclide ventriculography in patients with coronary artery disease and in normal volunteers. Both tests significantly increased heart rate and blood pressure. The reproducibility of serial evaluation of ejection fraction response to cold pressor and isometric handgrip stresses was satisfactory but the sensitivity for detecting coronary artery disease was not.Both Accepted for publication 24 November 1986 used to determine serial changes in the same patient.We have investigated the usefulness of both these interventions in the detection of coronary artery disease and their reproducibility in serial studies of left ventricular function. Patients and methodsThe protocol was approved by our local ethics committee and the Administration of Radioactive Substances Advisory Committee gave us permission to administer technetium-99m to three groups of subjects:Group 1 Sixteen symptom free male volunteers were recruited from hospital staff and associates. All were in sints rhythm; they were normotensive and lifelong non-smokers. They all had normal electrocardiograms at rest and during maximal graded exercise on a modified Bruce protocol.13 The chest x ray and the cardiothoracic ratio were normal, and no subject was taking any medication at the time of the study. None had evidence of valvar or congenital heart disease, respiratory disease, or peripheral vascular disease and all were presumed to have normal hearts (table 1).

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