The inspiration against a closed airway, the Mueller manoeuver, leads to a negative intrathoracic pressure. It is controversially discussed whether this is causing an augmentation of right heart murmurs. There is only limited knowledge on the temporal relationship of the negative intrathoracic pressure with right and left ventricular filling and stroke volume. To investigate this relationship, the flow through the mitral, aortic, tricuspid and pulmonary valves was studied continuously by Doppler echocardiography during a standardized Mueller manoeuver in 15 healthy subjects (age 45 +/- 10 years). Five heart beats after the initiation of the manoeuver, flow through the mitral and aortic valve decreased 12.2 +/- 7.2% (P less than 0.001) and 10.1 +/- 6.6% (P less than 0.001), respectively. A transient increase of 15.1 +/- 9.2% (P less than 0.001) in tricuspid flow was followed by a 14.3 +/- 9.8% (P less than 0.005) increase of flow through the pulmonary artery. Ten heart beats after the initiation of the Mueller manoeuver, flow through the pulmonary artery again reached baseline, while tricuspid flow remained below baseline values. In contrast to previous studies, our results indicate that the Mueller manoeuver causes a small and transient increase in right ventricular stroke volume which is unlikely to cause a marked augmentation in right heart murmurs.

Immunoscintigraphy with a technetium-99m murine monoclonal IgG1 antibody directed against non-specific cross-reacting antigen (NCA-95) and carcinoembryonic antigen was performed with 20 patients with suspected subacute infective endocarditis (SIE) and 6 controls with suspected inflammatory/infectious disease elsewhere in the body. Immunoscintigraphy and echocardiography localised SIE in 11 of 15 patients in whom the disease could be confirmed. In 4 patients with validated SIE, the immunoscan was abnormal, and the echocardiogram was normal. In another 4 patients, the result was exactly the opposite. These findings suggest that the combination of immunoscintigraphy and echocardiography improves diagnostic efficacy in patients with suspected SIE.

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A radioimmunoassay was developed to determine serum myoglobin (SMb). 50 healthy persons showed values between 0 and 90 ng/ml. Serial tests of 10 patients following acute myocardial infarction or during angina pectoris (AP) indicated that SMb reached pathological values before CK and CK-MB (average 250 +/- 95 ng/ml at the time of hospitalisation which corresponds to 3.3 +/- 1.4 h after beginning of angina pectoris). At hospitalisation the simultaneously determined CK was within normal limits and reached pathological values only 6.2 +/- 1.9 h after the onset of angina. Maximum of SMb was 506 +/- 194 ng/ml occurring 8.8 +/- 2.8 h after beginning of AP, maximum of CK was 905 +/- 475 mU/ml occurring 20.0 +/- 7.8 h after AP. CK-MB and CK differed only slightly in their time course. One patient with severe AP had pathologically increased SMb values whilst all other enzymes were completely normal. Methodical and clinical results are discussed.

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