Spironolactone is a safe, effective therapy for patients with refractory hypertension.

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The assessment of the severity of acute pulmonary embolism (PE) by imaging and Doppler echocardiography is prospectively studied in 48 patients (mean age 58.5 years). The examination includes the échographie measurements of the right and left end-diastolic ventricular diameters and the continuous wave (CW) Doppler estimation of the pulmonary artery systolic pressure using the peak velocity of the tricuspid regurgitation flow. The results are compared with the hemodynamic data obtained through catheterization and angiogram (Miller index). The pulmonary artery systolic pressures determined from CW Doppler and catheter examinations are well correlated (r = 0.92). Nine of the 11 patients with a tricuspid regurgitation velocity of more than 3.5 m/s present a clinical history of recurrent PE or of a chronic cor pulmonale. The right ventricular dilatation, almost always constant in severe PE, and the right ventricle diameter/left ventricle diameter ratio appear to be better correlated with the degree of the pulmonary vascular obstruction (r = 0.74; r = 0.7) than the assessed pulmonary artery systolic pressure (r = 0.44). Thus rapid evaluation of the cardiac effects, due to PE, by echocardiography and CW Doppler add important information of great diagnostic value.

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