Fifty three consecutive patients with acute myocardial infarction underwent two-dimensional echocardiography 1-3 days after admission. In order to (1) determine if this procedure can detect regional ventricular asynergy in an unselected series of patients. (2) to determine whether the procedure can identify patients at high risk for cardiogenic shock, before the onset of hemodynamic deterioration and (3) to identify the inmmediate complications of acute myocardial infarction. For purposes of analysis of the present protocol, the ventricles were divided in a system of walls, segments and levels resulting in 22 potential regions. Technically satisfactory two-dimensional echocardiographic studies were obtained in 48 patients (90.56%). Of 1056 possible segments in the 48 patients all were deemed adequate for analysis. Akinesis was detected in 2 segments (0.18%), dyskinesis in 45 segments (4.26%), hypokinesis in 170 (16.09%), hyperkinesis 15 (1.42%) and normal 824 (78.03%). The more segments damaged were observed by two dimensional echo, the more clinical and hemodinamically compromised status of the patients was assessed. The immediate complications were as follows: Pericardial effusion 20 cases (45.45%), ventricular dyskinesis 14 (31.81%), mural thrombosis (13.63%) papillary muscle dysfunction 3 (16.81%) ruptured septum in 1 (2.27%). Thus two-dimensional echocardiography performed soon after admission to the coronary care unit is technically feasible, provides useful information concerning regional and global left ventricular function and offers important predictive information about patients early in acute myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)