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The question of the clinical and economic feasibility of echocardiographic screening for cardiac disease in patients with symptoms of acute cerebral events was assessed by recording M-mode and two-dimensional (2D) echocardiograms in 170 patients. Patients with transient ischemic attacks or cerebral infarctions were included. Of the patients with satisfactory echocardiograms, 96 (56%) had normal diagnostic findings; 74 (43%) had cardiac disorders possibly related to the acute cerebral event. There were 4 patients who fulfilled the standard criteria for mitral valve prolapse and 7 patients who were identified as having probable cardiac thrombosis or vegetation, or both. Thus, M-mode and two-dimensional echocardiography was of limited value in patients referred for these studies for screening to exclude mitral valve prolapse and cardiac thrombosis or vegetation. Although a diverse range of cardiac disorders was demonstrated that may be associated with cerebral ischemia, the overall low yield does not support such screening and should be reserved for selected patients.

To examine the effects of acute myocardial infarction on mitral valve diastolic velocity, echocardiograms were performed in 18 patients on admission, daily in the Coronary Care Unit, and at 3-day intervals during the remainder of hospitalization. These patients were divided into three groups based on the time interval between onset of symptoms and initial echocardiogram. Five of six patients admitted within 5 hours of onset of myocardial infarction had a triphasic response of mitral valve diastolic velocity with a transient rise above initial values, followed by a fall to below initial values, and then a slow rise during recovery. Seven of eight patients admitted 1-2 days after onset of myocardial infarction had a biphasic response, i.e., a fall from initial values and then a slow rise. Four patients admitted later in the course of myocardial infarction had a monophasic response, i.e. low initial velocity followed by a slow recovery. We conclude that in patients with myocardial infarction the mitral valve diastolic velocity following myocardial infarction shows a triphasic response which may appear biphasic or monophasic depending on the interval between myocardial infarction and admission. The temporal pattern of mitral valve diastolic velocity changes may reflect the dynamic alterations of myocardial function and compliance that are occurring after acute myocardial infarction and during the recovery period.