Clinical Aspects
Patients show signs and symptoms of low cardiac
output (CO) associated with variable degrees of pulmonary
congestion. Cold sweating, mental confusion, oliguria,
tachycardia and filiform acceleration of the pulse, and
hypotension with approximation of the systolic and
diastolic levels of BP are often found and reflect the low
output.
Pulmonary congestion leads to hypoxemia and CO2
retention, and hence, to worsening of myocardial and cerebral
oxygenation, resulting in the appearance of mental
confusion and cardiac arrhythmias. Presence of the 3rd heart
sound, muffled heart sounds, jugular venous distention
and variable degrees of pulmonary rales are also often
found on physical examination. The appearance of cardiac
murmurs, initially absent, is important to establish the
diagnosis of post-AMI mechanical defects (ventricular
septal defect, papillary muscle dysfunction) and in the
complications of infectious endocarditis. The echocardiogram
is helpful in providing data on global and regional
ventricular function, integrity of valve function, and presence
of intracardiac shunts and of pericardial effusion 23.