Primary Myocardial Disease

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Abstract
The altered hemodynamics in primary myocardial disease (PMD) were investigated by right heart catheterization in 22 patients in 34 studies during clinical heart failure, following restoration of cardiac compensation, and at various intervals during the natural course of the disease. All but 2 patients had abnormal hemodynamics. The most frequent abnormal finding was a low cardiac output and a high resting A-V oxygen difference. Exercise accentuated these abnormalities. The pulmonary wedge pressure was always elevated during clinical heart failure. Isolated right heart failure was not observed, suggested predominate left ventricular failure. Pulmonary vascular resistance was minimally increased in contrast to the marked elevation frequently seen in left ventricular failure of other etiologies. Prior to restoration of cardiac compensation, the pulse contour from the right ventricle inscribed a prominent early diastolic dip which promptly disappeared after digitalization. This response to therapy suggested that myocardial failure was not due simply to mechanical restriction from interstitial fibrosis. The altered hemodynamics in PMD, with the exception of less striking elevation of the pulmonary vascular resistance, is similar to that seen in left ventricular failure of other etiologies.

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