Two-dimensional echocardiography (2DE) was performed in 64 patients with coronary artery disease. There were 46 men and 18 women, aged 58.7 +/- 11.4 years. An apical four-chamber view, a two-chamber right ventricular (RV) view, and a subcostal four-chamber view were obtained in 58 of 64 (91%) patients. Regional wall motion abnormalities ( RWMA ) of the RV free or diaphragmatic wall were detected in 4 of 18 (22%) patients with acute inferior myocardial infarction (IMI) and in 3 of 14 (21%) patients with old IMI. All seven patients with RWMA by 2DE had two or more of the following findings: hypotension, second- or third-degree atrioventricular block, atrial arrhythmias, or ventricular tachycardia. The RV ejection fraction by first-pass radionuclide angiography was 19.7 +/- 8.3% in patients with IMI and RV RWMA by 2DE compared to 35.3 +/- 9.6% (p less than 0.005) in patients without. A hyperdynamic RV wall motion was seen in 12 of 15 (80%) patients with acute anterior MI (AMI). No RV RWMA was observed in 17 patients with greater than 75% obstruction of right coronary artery and absent infarction. Thus, RWMA of the right ventricle were detected by 2DE in 22% of patients with IMI and identified patients with clinically significant RV dysfunction, probably due to RV infarction; a compensatory hyperdynamic RV wall motion was observed in 80% of patients with acute AMI.