The Pulmonary Vessels in Incipient Left Ventricular Decompensation Radiologic Observations

T HE APPEARANCE of clinical symptoms in a patient with an overloaded or weakened left ventricle generally provides the earliest evidence that the compensating cardiac mechanisms are no longer able to cope with normal physiologic demands.' If, however, clinical signs and symptoms appear only after a certain level or duration of left ventricular decompensation, then the asymptomatic, apparently compensated patients must include some in what might be termed "incipient" left ventricular decompensation.2' 3 It might be important to recognize such patients as an intermediate group; they may readily regress into the symptomatic group, or alternatively the symptoms might be anticipated or even prevented by appropriate therapy. The radiologist may contribute in this area by detecting objective evidence of left ventricular decompensation before clinical symptoms have appeared. Characteristic changes in the pulmonary vascular pattern are seen on the plain chest roentgenogram.