Pulmonary arterial diastolic pressure in acute myocardial infarction

Pulmonary arterial diastolic pressure has been shown to be a reliable estimate of left ventricular filling pressure. In 91 patients with acute myocardial infarction, the Swan-Ganz flow-directed catheter was used to measure pulmonary arterial diastolic pressure, which was correlated with clinical and radiographic estimates of left ventricular failure. The physical findings of a third sound gallop and rales were significantly correlated with the level of pulmonary arterial diastolic pressure. In the absence of either a third sound gallop or rales, the pulmonary arterial diastolic pressure was found to be increased in 47 percent of the patients. The presence of rales was a less sensitive determinant of left ventricular dysfunction than a third sound gallop alone or in association with rales. Radiographic findings of increasing pulmonary congestion were significantly correlated with the level of pulmonary arterial diastolic pressure. In the absence of radiographic pulmonary congestion, 24 percent of patients had abnormal pulmonary arterial diastolic pressure. We conclude that measurement of pulmonary arterial diastolic pressure increases the objectivity of the clinical evaluation in patients with acute myocardial infarction.