The injection of angiocardiographic contrast medium into the left side of the heart or the aorta is a common diagnostic procedure, and recent studies have described some of the haemodynamic responses which are produced (Brown et al., 1965;Friesinger et al., 1965;Rahimtoola, Duffy, andSwan, 1966, 1967). This study arose from the recognition of considerable increases in left ventricular enddiastolic pressure and left atrial pressure after injection of Hypaque 85 per cent (sodium and methylglucamine diatrizoate) during left heart catheterization. The purpose of this paper is to present data concerning the pressure changes in a series of 133 patients after the injection of radio-opaque dye, and to assess the value of taking serial pressure records.To help in the interpretation of the pressure changes, the alterations in blood volume, haematocrit, and cardiac output after injection of Hypaque have been measured in smaller groups of patients, and we have recorded pressures after exercise in some of these patients. PATIENTS AND METHODSSerial pressure changes after injection of radioopaque material were recorded and analysed from 133 patients during diagnostic catheterization, and these patients are grouped as follows: 7 with minimal heart disease regarded as "Normals"; 18 with mitral stenosis; 30 with mitral regurgitation; 18 with combined mitral stenosis and regurgitation; 19 with aortic stenosis; 23 with aortic regurgitation; and 18 with cardiomyopathy.Combined right and left heart catheterization was performed for diagnostic purposes in all patients. Left atrial and left ventricular catheterization was performed by transseptal puncture of the atrial septum. A second catheter was inserted percutaneously into the femoral artery, passed to the aortic root, and where possible into the left ventricle.Pressures were recorded immediately before the inReceived August 26, 1968. * In receipt of a grant from the British Heart Foundation. 233 jection of the radio-opaque dye and at intervals for 20 minutes after the injection, using equisensitive induction manometers and a multi-channel, oscilloscopic recorder (Cambridge Instrument Company). The zero baselines were set at 5 cm. below the sternal angle. The radioopaque dye used in all patients was 85 per cent Hypaque in a dose of j-1 ml./kg. body weight. The Hypaque was injected using a Gidlund power injection syringe at a pressure of 6-8 kg./cm.2 In 7 patients pressures were recorded serially after successive angiograms during the same catheter session. In 8 patients pressure changes after angiography have been compared with pressure changes after exercise. The degree of exercise was mild to moderate, and consisted of arm exercise for 3 to 5 minutes.Haematocrit estimations were made in 35 patients, and 18 of these are included in the group of 133 patients in whom serial pressure changes were recorded. Three baseline samples were taken before the angiogram, and determinations in duplicate were made within the first 3 minutes, and again at 5, 10, and 15 minutes after the injection ...

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