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To assess the clinical significance of pericardial effusion in Q-wave inferior wall acute myocardial infarction, 185 consecutive patients were examined by means of electrocardiogram, echocardlogram and hemodynamic monitoring. A pericardial effusion was present in 44 patients and was absent in 141 patients. Electrocardiographic right ventricular infarction (≥1 mm of ST-segment elevation and Q wave in V 4 R) was detected in 54 patients, with 20 patients having pericardial effusion. Patients with pericardial effusion had significantly more left ventricular segments with advanced asynergy, lower cardiac output, higher pulmonary artery wedge pressure and higher incidence of right ventricular infarction than those without pericardial effusion. There were 17 in-hospital deaths. Although there was no significant difference in the mortality rate between patients with and without right ventricular Infarction, a significantly higher hospital mortality rate was observed in patients with pericardial effusion compared to those without it (23 vs 5%). Pericardial effusion was selected with age and pulmonary artery wedge pressure as important variables associated with hospital mortality by the discriminant analysis. Patients who developed pericardial effusion, regardless of right ventricular infarction, had more extensive myocardial damage, and hence, pericardial effusion was one of the predictors of Increased hospital mortality.

To evaluate the relation between ST-segment analysis and microvascular reperfusion in patients with acute myocardial infarction (AMI), we studied 51 patients with first AMI who were successfully treated by percutaneous transluminal coronary angioplasty (PTCA). The lead showing the greatest ST-segment elevation on the 12-lead electrocardiogram (ECG) was serially investigated until 24 hours after PTCA. Successful reperfusion was determined by technetium-99m tetrofosmin single-photon emission computed tomography. Impaired reperfusion (group 1:4 change in the sum of the defect score from before to immediately after PTCA) was observed in 24 patients, and successful reperfusion (group 2) was observed in 27 patients. Although ST-segment elevation was reduced significantly at 30 minutes after PTCA in group 2 (2.2 +/- 1.4 to 1.7 +/- 1.3 mm, p = 0.01), there was no significant change in group 1 (1.9 +/- 1.9 to 2.4 +/- 1.7 mm). Ten of 14 patients (71%) with persistent ST-segment elevation (DeltaST0 mm change in ST segment from before to 30 minutes after PTCA0) were in group 1, whereas 23 of 37 patients (62%) with ST-segment resolution (DeltaSTor = 0) were in group 2. The sensitivity and specificity of persistent ST-segment elevation for predicting impaired microvascular reperfusion were 42% and 85%, respectively. Thus, persistent ST-segment elevation 30 minutes after primary PTCA was a highly specific electrocardiographic marker of impaired reperfusion in patients with AMI.

The clinical significance of infarct-associated pericarditis was examined in 201 consecutive patients with acute Q-wave myocardial infarction with successful direct percutaneous transluminal angioplasty. A pericardial rub was a reliable clinical sign of extensive myocardial damage in patients with direct angioplasty.

The Valsalva maneuver is a commonly practiced technique for the assessment of cardiac function. 1–5 Elisberg 2 found that heart rate response reliably reflects the hemodynamic change during the Valsalva maneuver. However, because many patients with congestive heart failure have an impaired response to catecholamine stimulation, heart rate response does not always reflect the change in left ventricular filling. Ear densitography is an ideal noninvasive technique to evaluate beat-to-beat hemodynamic change during the Valsalva maneuver, because it is reported to track the aortic pressure pulse pattern very closely during strain and release. 5 Since the Valsalva maneuver is frequently performed during daily activity, it is desirable to assess the cardiac response to the Valsalva maneuver in the more natural upright position. The present investigation evaluates the time course changes of heart rate and systolic time intervals during the Valsalva maneuver in the sitting and supine positions.

To elucidate the effect of pericardial effusion on pulmonary gas exchange in patients with infarction-associated pericardial effusion, 294 consecutive patients with their first Q-wave anterior wall acute myocardial infarction were examined carefully by echocardiography, chest radiography and hemodynamic monitoring. A pericardial effusion was detected in 77 patients and was absent in 217 (group 1). Of the 77 patients with pericardial effusion, it was mild in 57 (group 2) and moderate in 20 (group 3). Patients with pericardial effusion (groups 2 and 3) had significantly greater pulmonary artery wedge pressure and more left ventricular segments with advanced asynergy than did those in group 1. Although there were no significant differences in pulmonary artery wedge pressure and number of left ventricular segments with advanced asynergy between groups 2 and 3, group 3 had significantly greater right atrial pressure, alveolar arterial oxygen difference and incidence of high radiographic score. Thus, accumulation of pericardial effusion to a moderate amount may contribute to the greater incidence of increase in extravascular lung water, and disturbance of pulmonary gas exchange.