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Studying cardiovascular performance in acute myocardial infarction
Editorial
Studying Cardiovascular Performance Acute Myocardial Infarction ALBERT0
BENCHIMOL,
MD,
FACC
For the past few years, a significant amount of physiologic data has been accumulated on patients with acute myocardial infarction. These findings have provided an opportunity to define ventricular performance and, therefore, have led to a better understanding of the hemodynamic consequences of acute coronary occlusion. It is hoped that this large body of information will result in better management of patients with acute myocardial infarction and decreased mortality. The work by Lassers et al.,l published in this issue, indicates the feasibility and safety of performing cardiac catheterization procedures in patients with an acute myocardial infarction. The poor correlation between the elevation of pulmonary arterial “wedge” pressure levels and the presence of dyspnea, basal rales and third and fourth heart sounds is somewhat of a surprise but not completely unexpected. Left ventricular failure may be present in patients with normal left ventricular end-diastolic pressure or left atria1 pressure (severe myocardial disease). On the other hand, elevation of left ventricular end-diastolic and left atria1 pressure levels may he seen in patients
From the Institute for Cardiovascular Diseases, Good Samaritan Hospital, Phoenix, Ark Address for reprints: Albert0 Benchimol, MD, 1033 East McDowell Rd., Phoenix, Ark. 85006.
VOLUME
25, MAY 1970
in
with left ventricular disease secondary to aortic stenosis, hypertension and coronary artery disease, among others, even when there is no clinical manifestation of heart failure. In both situations, marked alterations in ventricular compliance probably provide the most likely explanation. Unfortunately, there are still no adequate techniques to expose changes in ventricular compliance. Although the present studies by Lassers et al. describe important physiologic information directly applicable to clinical cardiology, cardiac catheterization techniques have the disadvantages of all traumatic and invasive approaches to the study of ventricular functions. It is hoped that in time adequate measurements of various indexes of cardiovascular performance can be obtained by atraumatic and noninvasive methods. In one approach being developed, measurements of phasic arterial blood velocity are obtained by using the ultrasonic Doppler technique with transcutaneous probes placed directly over superficial arteries in the body. Such techniques may prove to be a useful step forward.
Reference 1. Lassers BW, George M, Anderton JL: failure in acute myocardial infarction. Amer J Cardiol 25:511-522, 1970
Left ventricular
619
Studying Cardiovascular Performance Acute Myocardial Infarction ALBERT0
BENCHIMOL,
MD,
FACC
For the past few years, a significant amount of physiologic data has been accumulated on patients with acute myocardial infarction. These findings have provided an opportunity to define ventricular performance and, therefore, have led to a better understanding of the hemodynamic consequences of acute coronary occlusion. It is hoped that this large body of information will result in better management of patients with acute myocardial infarction and decreased mortality. The work by Lassers et al.,l published in this issue, indicates the feasibility and safety of performing cardiac catheterization procedures in patients with an acute myocardial infarction. The poor correlation between the elevation of pulmonary arterial “wedge” pressure levels and the presence of dyspnea, basal rales and third and fourth heart sounds is somewhat of a surprise but not completely unexpected. Left ventricular failure may be present in patients with normal left ventricular end-diastolic pressure or left atria1 pressure (severe myocardial disease). On the other hand, elevation of left ventricular end-diastolic and left atria1 pressure levels may he seen in patients
From the Institute for Cardiovascular Diseases, Good Samaritan Hospital, Phoenix, Ark Address for reprints: Albert0 Benchimol, MD, 1033 East McDowell Rd., Phoenix, Ark. 85006.
VOLUME
25, MAY 1970
in
with left ventricular disease secondary to aortic stenosis, hypertension and coronary artery disease, among others, even when there is no clinical manifestation of heart failure. In both situations, marked alterations in ventricular compliance probably provide the most likely explanation. Unfortunately, there are still no adequate techniques to expose changes in ventricular compliance. Although the present studies by Lassers et al. describe important physiologic information directly applicable to clinical cardiology, cardiac catheterization techniques have the disadvantages of all traumatic and invasive approaches to the study of ventricular functions. It is hoped that in time adequate measurements of various indexes of cardiovascular performance can be obtained by atraumatic and noninvasive methods. In one approach being developed, measurements of phasic arterial blood velocity are obtained by using the ultrasonic Doppler technique with transcutaneous probes placed directly over superficial arteries in the body. Such techniques may prove to be a useful step forward.
Reference 1. Lassers BW, George M, Anderton JL: failure in acute myocardial infarction. Amer J Cardiol 25:511-522, 1970
Left ventricular
619