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The aim of this prospective study was to assess the value of complementary investigations in the diagnosis and follow-up of embolic heart disease. Forty-six patients having presented a systemic embolism cardiac origin underwent a standard work up which included clinical examination, ECG, chest X-ray and 2D echocardiography. Other investigations were carried out in some patients: CT cardiac scan (11 cases), gamma scintigraphy with Indium III labelled platelets (6 cases) and angiocardiography (12 cases). The diagnosis of an embolic cardiac lesion was made after the standard investigations in 82% of cases. The remaining 18% of cases hall had echocardiographic abnormalities and enable the diagnosis of clinically imapparent conditions: mitral valve prolapse, aneurysm of the interatrial septum, valvular calcification and cardiomyopathy. A potentially embolic mass was visualised in 18 patients; 6 valvular vegetations, 12 left atrial or ventricular thrombi. The other specialised radionuclide, angiographic and CT investigations only confirmed the echocardiographic diagnosis of intravavitary thrombosis. These results were confirmed surgically in 19% of cases. This study shows that complementary investigations especially echocardiography, allow diagnosis of latent embolic cardiac lesions, some of which may benefit from surgical treatment. In addition, potentially embolic intracardiac masses may be visualised, so confirming the origin of systemic emboli. When surgery is not indicated, echocardiography is a good method of following up the results of medical treatment in some of these masses.

Cardiac failure is usually defined according to clinical and haemodynamic criteria at rest although these patients are mainly symptomatic on effort. Is it possible to substitute or associate a more "objective" method to the NYHA functional classification such as exercise stress testing? If so, is there a correlation between these two types of classification and resting haemodynamic data; have they any predictive value of the patient's exercise capacity? Twenty two patients with severe cardiac failure (Class III or IV of the NYHA), 18 men and 4 women with a mean age of 58 years, underwent a triangular exercise stress test on a bicycle ergometer to 80 p. 100 or more of their theoretical maximal heart rate. The ergometric parameters chosen for the study were the maximal oxygen consumption or its value when limited by symptoms, the maximal work with respect to weight, the total duration of exercise and the percentage increase in systolic blood pressure. The haemodynamic parameters chosen were pulmonary capillary pressure, systolic index, ejection fraction and the velocity of circumferential fibre shortening. No correlation was found between the NYHA functional class and exercise capacity. A dissociated correlation was observed between exercise capacity and resting haemodynamic data. The best correlation was between systolic index and exercise capacity (work performed corrected for body weight, r = 0.70, p less than 0.01; oxygen consumption, r = 0.60, p less than 0.01). After one month of treatment with a vasodilator (Prazosin) in 10 patients, the duration of exercise increased by 2.2 +/- 0.5 min.(ABSTRACT TRUNCATED AT 250 WORDS)

The distinction between precordial pain of cardiac origin and pain of extra-cardiac origin is a daily problem. We wanted to study the value of echocardiography in this difficult diagnostic problem. In a series of 148 patients admitted to the unit in 1982 for chest pain. 104 were investigated by echocardiography and coronary angiography. In 36 per cent of patients, the echocardiogram was normal and was unable to predict the presence or absence of coronary artery disease. Further investigations seem to be justified in these cases. In 57 per cent of cases, the echocardiogram was abnormal, suggestive of a cardiac cause for the pain. The demonstration of a disorder of segmental kinetics in the left ventricle is suggestive of coronary artery disease, which is detected 82 per cent of cases and is a good indication for coronary angiography. The other abnormalities detected, mitral valve prolapse, hypertrophic cardiomyopathy and dilated cardiomyopathy are rarely associated with coronary artery disease, which was found in 0, 13 and 14 per cent of cases, respectively. Initially, these abnormalities may be sufficient to explain the symptomatology. Pericardial detachments are associated with coronary artery lesions in 50 per cent of cases and should be very carefully monitored.

An observation of angina aggravated in a concomitant manner with the introduction of treatment with beta blockers is reported. The exacerbation of a vasospastic component with this treatment is evoked on clinical, electrical and coronarographic grounds.