Br Heart J 1980; 43: 702-4
Abnormal diastolic motion of interventricular septumduring inspiratory phaseEchocardiographic studyALDO IERI, ANDREA ZIPOLI
From the Cardiovascular Center of San Pietro Hospital of Fucecchio, Florence, Italy
SUMMARY We report on a patient without heart disease who had pulsus paradoxus, associated withechocardiographic evidence of abnormal and exaggerated diastolic motion of interventricular septum.Both phenomena appeared at the peak of the inspiratory phase of respiration, and seemed to beproduced from the same haemodynamic variations, of which the echocardiographic pattern appears
to be a more sensitive index than the sphygmographic one.
Echocardiography has made possible the study ofinterventricular septal motion. Using this method,it has been shown that the interventricular septumpresents abnormalities, both in direction and extentof movement, as a result of pathological change orbecause of exaggerated physiological variations.'It is known that, particularly in young people, theinterventricular septum can show a periodicdisplacement with the different phases of respira-tion.2To our knowledge, no case of abnormal diastolic
motion of the interventricular septum, related tothe peak of inspiration and as exaggerated as in ourpatient, has been reported in a subject withoutheart disease.
Case report
A 53-year-old man without any significant complaintwas seen as an outpatient. The electrocardiogramwas normal; and the chest x-ray films were alsonormal, except for evidence of moderate pulmonaryemphysema which was confirmed by pulmonaryfunction tests. Phonomechanographic examinationshowed a reduction in peripheral pulse amplitudeduring inspiration. The subject was normal in everyother respect.The echogram showed no alteration, except for
an abnormal motion of the interventricular septumat the peak of inspiration (Fig. 1).A reduction in arterial pulse amplitude was
observed in every first beat after the abnormalseptal motion (Fig. 2).
The average values of systolic and diastolicdimensions of the ventricles, both in inspiratoryand expiratory phases, are reported in the Table.
It is apparent that at the peak of inspiration theright ventricular diastolic dimension was largerthan in expiration, so that it was equal to the leftventricular diastolic dimension.
In the left ventricle, during inspiration, the usualsystolic shortening of the internal transversediameter was almost absent. But such systolicshortening was unusually high in the right ventriclein the same respiratory phase. It appeared to bedependent on the abnormal diastolic septal motion.
Discussion
The exaggerated paradoxical septal motion in thiscase was clearly connected to the phases of respira-tion. It appeared exclusively at the peak of inspira-tion, namely whenever intrathoracic negativepressure reached its maximum. It seems justifiable
Table Average values (mm) of right and left ventricularinternal diameters (RVID and LVID) in systole anddiastole and during inspiratory and expiratory phases
Inspiration Expiration
Diastole 46 29RVID
Systole 24 24
Diastole 38 55LVID
Systole 42 40
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Abnormal diastolic motion of interventricular septum during inspiratory phase 703
Fig. 1 Right and left ventricleM-mode echogram. Paper speed:10 mm/s. Respiratory tracing isrecorded. Abnormal septalmovements are observed at thepeak of inspiratory phases.RV, right ventricle; IVS,interventricular septum; R T,respiratory tracing; PLVW,posterior left ventricular wall;ECG, electrocardiogram
Fig. 2 Right and left ventricleM-mode echogram. Paper speed:25 mm/s. Recording of rightbrachial external pulse tracing.A reduction in pulse amplitude isevident in the first beat afterabnormal septal motion. BPT,brachial pulse tracing; otherabbreviations as in Fig. 1.
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-ECG .: .: . . .. :::
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Aldo Ieri, Andrea Zipoli
to suppose that the abnormal septal motion was a
consequence of haemodynamic variations producedfrom the lowering of intrathoracic pressure. Sucha lowering might be unusually pronounced in ourpatient, because of his pulmonary emphysema.During inspiration, right ventricular diastolic
filling increased conspicuously, while left ventriculardiastolic filling was reduced; consequently, an
abnormal septal motion appeared. Therefore, thenegative intrathoracic pressure, while increasingthe systemic venous return, also leads to increasedpooling of blood in the lungs, so reducing leftventricular preload.3 (Systemic venous return isfurther enhanced by abdominal venous compressionas the diaphragm descends.)
In Fig. 2 echocardiographic evidence of paradoxi-cal septal motion is more apparent than thesphygmographic pattern of pulsus paradoxus, withthe implication that the former appears to be amore sensitive index of haemodynamic variationswhich are able to produce both phenomena.
In the present study we showed that the reductionin pulse amplitude was relatively small, and, sincethe transverse left ventricle diameter did not showvariation in systolic shortening, it seems likely thatthe stroke volume was preserved by the shorteningof the left ventricular diameters other than trans-verse.
References
1Assad-Morrell JL, Tajik AJ, Giuliani ER. Echocardio-graphic analysis of the ventricular septum. ProgCardiovasc Dis 1974; 17: 219-37.2Meyer RA. Pediatric echocardiography. Philadelphia:Lea & Febiger, 1977.3Guyton AC. Circulatory physiology: cardiac output andits regulation. Philadelphia: W B Saunders, 1963.4Hurst JW, Schlant RC. Examination of the arteries.In: Hurst JW, Logue RB, eds. The heart, arteries andveins. New York: McGraw-Hill, 1970: 170-82.
Requests for reprints to Dr Aldo Ieri, Via PPetrini 6, Pistoia 51100, Italy.
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