A routine 12-lead electrocardiogram was normal in only two of 11 patients. Nonspecific ST segment changes were present in seven patients, one patient had right atrial enlargement, one had left atrial enlargement with evidence of a previous myocardial infarction, one had left ventricular hypertrophy, and another had right bundle branch block. Echocardio-graphic data revealed all patients to have normal left ventricular ejection fractions (mean, 60 ± 11 percent). In contrast to normal left ventricular function, seven patients had echocardiographic evidence of pulmonary hypertension (Table 1). The diagnosis of pulmonary hypertension was based on a reduced acceleration time with associated pulmonic valve motion abnormalities in five patients and on the basis of secondary criteria in two patients (No. 5 and 8) in whom technically adequate Doppler studies could not be obtained. All Doppler studies were performed at heart rates between 60 to 100 beats per minute except for patient 1 (54 beats per minute) and patient 7 (56 beats per minute). Correcting the acceleration time for heart rate would not have changed the results in either patient. buy flovent inhaler
Six patients had no radiographic evidence of parenchymal lung disease, but two of these individuals had an increased hilar/thoracic index suggestive of pulmonary hypertension (Table 1). Four patients had increased interstitial markings consistent with mild pulmonary fibrosis. One patient had unsuspected left lower lobe atelectasis without evidence of other parenchymal disease.