DIASTOLIC PLATEAU WAVE OF PULMONARY-ARTERY PRESSURE IN SEVERE CONGESTIVE-HEART-FAILURE

We describe 3 cases of severe congestive heart failure. The patients e xhibited a marked decrease in transmitral flow velocity during atrial contraction and an abnormal diastolic plateau wave of pulmonary artery pressure (PAP). The first patient was a 60-year-old man with acute my ocardial infarction and acute renal failure in whom pulmonary capillar y wedge pressure (PCWP) was raised to 20 mmHg. Pulsed Doppler echocard iography revealed a marked decrease in transmitral flow velocity durin g atrial contraction, and the PAP waveform showed a mid to late diasto lic plateau wave. Treatment for congestive heart failure reduced PCWP to 10 mmHg and the PAP waveform returned to normal. Doppler examinatio n revealed the normal transmitral flow velocity pattern. The second pa tient was a 37-year-old woman with subarachnoid hemorrhage and the thi rd patient a 74-year-old man with acute myocardial infarction. In thes e patients, the PAP waveform also showed a diastolic plateau wave, whi ch was abolished by treatment. We believe that the diastolic plateau w ave of PAP indicates left ventricular diastolic dysfunction and marked elevation of left ventricular filling pressure.