SERIAL OBSERVATIONS ON LEFT VENTRICULAR DYSFUNCTION IN ACUTE MYOCARDIAL INFARCTION: I. Gallop Sounds, Ventricular Asynergy and Radiological Signs

Abstract. The occurrence and significance of various signs of left heart pump failure have been studied serially in 50 patients with acute myocardial infarction (AMI) 1, 2, 3, 5, 10, 15, and 20 days after the onset of symptoms. The clinical severity of AMI, the findings on cardiac palpation and auscultation, the electro-, phono-, and kinetocardiographic findings and the radiological signs of left ventricular failure were evaluated. Evidence of left ventricular dysfunction was observed in all patients: atrial gallop in 100% (audible in 82%), a high a wave kinetocardiographically in 92%, ventricular gallop in 90% (audible in 80%), papillary muscle dysfunction in 58%, ventricular asynergy kinetocardiographically in 100% (a palpable paradoxical pulsation in 86%), pulmonary rales in 70%, pulmonary vascular congestion in serial X-rays in 98%, and enlargement of the heart in 42%. These signs developed during the first days, also in patients with normal-sized hearts, and persisted in the majority. Because of their high prevalence, auscultatory and phonocardiographic signs of myocardial dysfunction and, similarly, ventricular asynergy as demonstrated by palpation and kinetocardiography, if assessed cross-sectionally, were not useful in assessing the hemodynamic severity of AMI or its prognosis. However, serial studies indicated that changes in the clinical course of AMI are accompanied by parallel changes in the clinical signs of left ventricular dysfunction. Radiological signs of pulmonary vascular congestion and electrocardiographic signs of left atrial overloading are valuable in the assessment of the clinical severity and course of AMI.