Clinical and Radiological Signs of Left Ventricular Failure in Acute Myocardial Infarction

To analyse the value of clinical signs and chest X‐ray parameters in the diagnosis of left ventricular (LV) failure in proven acute myocardial infarction a correlative study has been performed in 110 patients during the first three days of hospitalization, whilst in the Coronary Care Unit. The clinical signs assessed were: 1) third heart sound, 2) basal crepitations, mild and marked, and 3) frank pulmonary oedema. The radiological parameters indicative of LV failure were: 1) pulmonary vessel (venous) dilatation, moderate and marked, 2) pulmonary oedema, patchy and diffuse, 3) Kerley's (septal) lines, and 4) pleural effusion. The incidence of LV failure on the first three days, if clinical signs only were utilized, was 31%, 30% and 14%, respectively. If radiological signs only were used, the incidence of LV failure on days 1, 2 and 3 was 56%, 43% and 29%, respectively. If both clinical and radiological findings were used, the incidence of LV failure on days 1, 2 and 3 was 60%, 48% and 34%, respectively. A total of 45 of the 110 patients (41%) showed clinical evidence of LV failure, and 63 (57%) showed radiological evidence of LV failure. These figures do not include the patients who died shortly after admission, before a chest X‐ray could be taken. The chest X‐ray proved to be more sensitive in the detection of LV failure, and it also detected LV failure earlier. LV failure was detected in the chest X‐ray, one day earlier than by clinical signs, in 17% of these patients with LV failure. Intra‐alveolar pulmonary oedema, shown in the X‐rays, was not associated with clinical signs in 43% of cases. The earliest radiological parameter of LV failure was pulmonary vessel dilatation, which gives rise to no auscultatory signs.