Echocardiographic findings of ventricular septal rupture in acute myocardial infarction.

Echocardiograms were recorded both before and after the clinical appearance of an autopsy-confirmed interventricular septal rupture in a patient with an acute myocardial infarction. The major findings were related to the upper portion of the interventricular septum. Before rupture, this portion of the septum was relatively akinetic with a slight anterior motion during systole, whereas after rupture there was a marked increase in the amplitude of septal motion with abrupt posterior motion occurring with the onset of ventricular diastole.

Echocardiographic findings in isolated, surgically created tricuspid insufficiency.

The effects of surgically created tricuspid insufficiency on the right ventricular dimension and the motion of the interventricular septum were determined by serial echocardiography in a patient with a hemodynamically normal heart who underwent tricuspid valvulectomy and later tricuspid valve replacement for medically intractable bacterial endocarditis. Initially, both the right ventricular dimension (1.8 cm) and motion of the interventricular septum were normal. After valvulectomy interventricular septal motion became distinctly paradoxical (pattern A, later pattern B), and the right ventricular dimension progressively increased to 3.5 cm. After successful tricuspid valve replacement interventricular septal motion promptly returned toward normal as did the right ventricular dimension (2.2 cm). The rapid changes in these echocardiographic variables with creation and relief of acute right ventricular volume overload correspond well with results of previous work in experimental animals but differ from findings in man with chronic right ventricular volume overload.

Echocardiographic diagnosis of intraventricular clot.

The literature contains many reports of the echocardiographic findings in left atrial myxoma and clot; however, descriptions of left ventricular thrombus or tumor are rare. We discuss here the echocardiographic findings in a patient with a large apical left ventricular thrombus which was confirmed both angiographically and pathologically. The importance of echocardiographically examining the area below the mitral valve near the apex of the left ventricle, where most of the thrombi are located, is stressed.

Persistence of biologic activity after disappearance of propranolol from the serum.

In order to evaluate the duration of the biologic effects of propranolol after the drug was discontinued, we evaluated a variety of noninvasively determined hemodynamic parameters. Significant depression was found in the heart rate (18 per cent), cardiac output (13 per cent) (determined echocardiographically), and the triple product of blood pressure, heart rate, and systolic ejection time (16 per per cent) during administration or propranolol (200 mg. per day) to 9 normal volunteers. Significant depression of these parameters was present 12 hours after discontinuing the drug. By 12 hours, serum propranolol levels had returned 90 per cent toward their base line; however, at the same time, the heart rate and cardiac output had returned only 19.4 and 14.3 per cent toward their base-line values, and the triple product had returned 41 per cent toward its baseline. By 36 hours no biologic effect was seen. Thus if propranolol were discontinued 2 days prior to cardiac surgery, no significant biologic effect would remain to complicate the patient's postoperative course.

Distribution of coronary artery disease. Prediction by echocardiography.

To assess the sensitivity of standard echocardiography in detecting ventricular motion abnormalities in patients with coronary artery disease (CAD) without prior myocardial infarction, 56 consecutive patients with a history of angina pectoris were studied during an angina-free period. In the 48 patients with adequate echocardiograms, the amplitude of septal and posterior wall motion in the high, mid, and low left ventricle was determined and used to predict prospectively in a blinded fashion the sites of angiographically-determined CAD. Twenty-eight of 35 patients (80%) with disease of the left anterior descending artery (LAD) had diminished interventricular septal motion (P less than 0.001) and 14 of 27 patients (52%) with disease of posterior vessels had diminished posterior wall motion on echocardiogram. When abnormalties of echocardiographic wall motion were compared with left ventriculography, the results were similar. Echocardiography may aid in predicting the presence and distribution of CAD, especially LAD disease.