No abstract

It has been suggested that the presence of increased respiratory variation in mitral flow velocity (RVIMFV) in patients with pericardial effusion (PE) represents significant hemodynamic compromise regardless of the amount of PE or 2D-echo findings. Recent experimental data do not, however, support this aspect. The aim of this study was to evaluate the relation of RVIMFV to clinical, hemodynamic, and 2D-echo findings in patients with PE and cardiac tamponade (CT). Therefore, 11 patients with PE and CT were studied with right-heart, pericardial, and arterial pressure measurements in conjunction with 2D and Doppler echocardiography during three stages of gradually decreasing PE, ie, (1) before any PE drainage, (2) after partial PE drainage, and (3) after full drainage. A significant RVIMFV was noted during all three stages of our study. It was maximal at the early stage [respiratory difference in mitral flow velocity (delta MFV): 16.8 +/- 6.3 cm/sec, 24.1%, P = 0.0000026] coinciding with pulsus paradoxus, high pericardial pressure, and diastolic right heart collapse, and it decreased slightly after partial drainage when all signs of CT receded (delta MFV: 13.7 +/- 9.7 cm/sec, 18%, P = 0.00043). However, there was still some RVIMFV (delta MFV: 8.7 +/- 7.6 cm/sec, 13.9%, P = 0.0017) after full pericardial drainage. It is concluded that the presence and the magnitude of RVIMFV is not predictive of hemodynamic compromise in patients with PE.

The aim of this study was to assess the value of the early exercise test (ET) in patients with acute myocardial infarction (AMI) treated with IV streptokinase (SK). The authors studied 70 patients with first AMI; 31 were treated with SK and 39 were not. Before discharge everyone was given early exercise up to 5-6 METs and catheterized within 22.9 +/- 7.2 days. There was no significant difference in the number of positive ETs between the two groups (11/31 and 14/39 respectively). There was significant difference in favor of: (1) the recanalization of the infarct-related artery in the SK group, (2) the negative ET in patients with recanalized vessels in both groups, (3) the positive ET in patients with multi-vessel coronary disease. It is concluded that the results of early ET in patients with AMI are related to the recanalization of the infarct-related artery and the coexistence of multi-vessel coronary artery disease, regardless of SK treatment. Patients with successful thrombolysis have negative ET more frequently.

SUMMARY The effects of coronary artery surgery on left ventricular performance were assessed serially by echocardiography and treadmill exercise testing in 54 patients. Patients were assessed one day before operation and again before patients left hospital (mean 10 days after operation) and one month and six months after operation. At the predischarge assessment, 41 (77%) patients showed new abnormalities of left ventricular segmental wall movement, chiefly anteroseptal hypokinesia with hyperkinesia of the posterolateral segment. Although there were no significant changes in anteroseptal wall thickening after operation, there was a significant increase in posterior wall thickening at all postoperative assessments. The frequency of this abnormality decreased progressively after operation; it persisted in 19 (35%) patients at six months. Left ventricular fractional shortening decreased after operation and at one month was significantly less than before operation. There were no significant changes in left ventricular diastolic diameter during the study. Haemodynamic function during exercise, the duration of exercise, and features of reversible myocardial ischaemia all improved progressively and significantly after coronary artery surgery.Abnormalities