Clinical significance of the V wave in the main pulmonary artery

Noninvasive detection by Doppler echocardiography of combined ventricular septal rupture and mitral regurgitation in acute myocardial infarction

The diagnosis of combined ventricular septal rupture and mitral regurgitation complicating acute myocardial infarction is difficult and in previously reported cases has required right and left heart catheterization. This study utilized simultaneous Doppler and two-dimensional echocardiography to diagnose these combined lesions in two cases. Doppler echocardiography should have its greatest impact in the early noninvasive diagnosis of these complications.

Pitfalls in bedside diagnosis of severe acute mitral regurgitation. Clinical and hemodynamic features

We describe five patients with severe acute mitral regurgitation in whom delay in diagnosis contributed to their fatal outcome. Either a soft systolic murmur was not heard or was misinterpreted, or hemodynamic confirmation by bedside right heart catheterization was unduly delayed. Pitfalls in recognition of hemodynamic patterns further postponed diagnosis and therapy. The diagnosis should be suspected when, in the proper setting, significant hemodynamic deterioration occurs, and is confirmed by bedside balloon flotation catheterization. Large V waves, characteristic of acute mitral regurgitation, may be overlooked unless one pays attention to the pulmonary artery systolic pressure tracing, which often has a triangular shape and may be double peaked; the V wave occurs later causing the second peak. Careful balloon inflation will demonstrate the large V waves. Timing with simultaneous ECG recordings allow this differentiation. Pulmonary hypertension with normal pulmonary vascular resistance is typical.

Unexpected giant "V" waves during pulmonary artery catheterization

Two cases of catheterization of the pulmonary artery, in which the hemodynamic findings were very different from the initial clinical diagnosis, are presented. The importance of verifying the adequate position and motion of the pulomonary artery catheters with two consecutive chest x-rays is discussed. In particular, attention is brought to the possible misinterpretation that occurs in patients with very elevated pulmonary artery mean pressure.

Hemodynamic compromise associated with ventriculoatrial conduction following transvenous pacemaker placement

Ventriculoatrial conduction complicating ventricular pacing in a patient with ischemic heart disease led to severe clinical disability and hemodynamic compromise. Data obtained at cardiac catheterization documented that ventriculoatrial conduction of the patients' paced beats led to inadequate left ventricular filling pressures, pulmonary congestion and depressed cardiac output. This complication of ventricular pacing can be suspected at bedside examination and emphasizes the importance of considering the possible hemodynamic effects of ventricular pacing when long-term pacemaker therapy is contemplated.