A false positive diagnosis is made in approximately 25% of patients who are considered to have angina pectoris on an arteriosclerotic basis. The opportunity arose to examine 12 patients during spontaneous bouts of angina and attention was directed to the presence or transient development of pulsus alternans, abnormal precordial pulsations, paradoxical splitting of the second sound, atrial or ventricular diastolic gallops, an apical regurgitant murmur, and the response of the pain to carotid sinus pressure. At rest, 11 of the 12 patients had an atrial and six had a ventricular diastolic gallop. In ten out of 12 instances, abnormal physical findings became manifest and/or carotid sinus pressure was effective in relieving the angina. The observation of transient physical signs of left ventricular dysfunction may help resolve a difficult diagnostic problem.