NEGATIVE TREADMILL EXERCISE TEST RESULT WITH SUBSEQUENT MYOCARDIAL INFARCTION AND CORONARY ARTERY BYPASS: CASE REPORT.

Myocardial infarction is a rare complication of maximal exercise testing.(1) In the case presented here, infarction occurred in a 54-year-old man, 14 minutes after he showed a normal response to maximal multistage treadmill exercise testing. The presence of coronary artery disease had been documented angiographically prior to exercise testing. After infarction, the patient underwent emergency double aortocoronary bypass to the left anterior descending and right coronary arteries with good results. Clinical evidence suggests that the extent of myocardial necrosis was reduced by timely surgical intervention. There is no conclusive explanation for this patient's normal response to maximal exercise testing in the presence of advanced coronary artery occlusive disease followed rapidly by infarction. The value of exercise testing is well established in assessing the existence or severity of coronary artery disease; a normal response, however, cannot be used as an infallible indication that critical coronary artery disease does not exist.

SILENT MYOCARDIAL INFARCTION WITH POSTERIOR INFERIOR PSEUDOANEURYSM OF THE LEFT VENTRICLE PRESENTING AS A POSTERIOR LUNG MASS.

An asymptomatic 62-year-old man developed a density in his left lower hemithorax in the retrocardiac position on chest roentgenogram, which was discovered during a routine evaluation. This was diagnosed in another hospital as a lung tumor, for which he underwent an exploratory left thoracotomy. This case points out the difficulty in the diagnosis of retrocardiac masses and suggests that echocardiography and cardiac angiography should be accomplished before attempting needle aspiration or an open lung biopsy. The absence of a history of myocardial infarction and classical clinical indications of ventricular aneurysms such as electrocardiographic changes, arrhythmias, and congestive heart failure does not exclude a true aneurysm or pseudoaneurysm of the left ventricle.

SEVERE PULMONARY HYPERTENSION WITH SIGNIFICANT "A" DIP ON PULMONIC VALVE ECHOCARDIOGRAM.

A patient with severe pulmonary hypertension and no evidence of right ventricular failure who had a 4 mm "a" dip on the pulmonic valve echocardiogram is reported. Although other echocardiographic abnormalities suggesting pulmonary hypertension were recorded in our patient, the normal "a" dip of the pulmonic valve in the absence of right ventricular failure appears to be an exception to previously reported findings. We suggest motion of the entire pulmonary artery as an explanation for this phenomenon.