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Summary Cardiovascular instability following burns may result from either cardiac or non-cardiac causes. We illustrate three cases in whom routine measurements of atrial filling pressures and cardiac output alone did not reject the adequacy of blood volume or the myocardial performance. In each instance, measurements of ventricular volume and ejection fraction by thermodilution technique or ppmTC ventriculography were useful to determine the actual causes of decreased cardiac output. Heart; output, ventricles. Intensive care. Cardiac instability in burned patients can result from hypovolaemia, burn-induced direct myocardial depression, or sepsis. The secondary effects of therapy with positive end expiratory pressure (PEEP)* and drugs, particularly anaesthetics3 can further aggravate cardiovascular instability. Measures most commonly used to assess the adequacy of cardiovascular function, i.e., urine output, central venous (CVP) and pulmonary capillary wedge pressures (PWP), and cardiac index (CI) may be inadequate in certain critically . - ill patients4 For example, assessment of cardiac functionby filling pressures can be misleading when airway pressure is increased, as with PEEP2 or when ventricular compliance is altered because of hypertrophy, pericardial effusion, or drugs.’-’ Under these circumstances, increased filling pressures can be found in the presence of hypovolaemia and normal myocardial contractility. This can lead to an erroneous conclusion about the cause of the cardiovascular instability.

Summary: In this report, we present the pre and late postoperative course of a patient with severe angina secondary to aberrant origin or the left coronary artery from the proximal right coronary artery (Fig. 1). We illustrate the noninvasive diagnosis and evaluation of this patient by two-dimensional ultrasound and stress thallium imaging, and the pre and late postoperative angi-ographic and thallium perfusion findings.