ACS-Echo

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Acute Coronary Syndrome:Echocardiography : 

Acute Coronary Syndrome:Echocardiography August 18, 2008

Echo Basics : 

Echo Basics Routine echocardiography views allow for imaging of the anterior, inferior, posterior and lateral walls from different locations in the heart (from the base of the heart in the plane of the mitral valve to the apex) Echo signs of ischemia/infarction: Wall motion abnormalities (hypokinetic, akinetic) Reduced ejection fraction Mechanical complications of infarction (ischemic mitral regurgitation, VSD, myocardial rupture)

Slide 4: 

Inferior wall motion abnormality: Seen best on axis view and parasternal long view Sign of infarction in posterior descending artery or distal left circumflex artery Images courtesy of - http://www.med.yale.edu/intmed/cardio/echo_atlas

Slide 5: 

Images courtesy of - http://www.med.yale.edu/intmed/cardio/echo_atlas Anterior wall motion abnormality: - Seen best on short axis view and 4 chamber view Sign of infarction involving the left Anterior descending artery

Echo Evaluation of ACS : 

Echo Evaluation of ACS Initial Emergency Department Triage Suspected ACS Wall motion abnormality can provide insight into extent of ischemic myocardium If non-diagnostic EKG, then echo can demonstrate ischemic wall motion abnormalities Chest pain but unclear ACS  can use echo to evaluate: Pericarditis/pericardial effusion Hypertrophic Cardiomyopathy Valvular heart disease Aortic dissection (proximal aorta – otherwise need TEE or CTA) Pulmonary Embolism (increased pulmonary artery pressure)

Slide 7: 

Circulation 1982;65:323-329 Immediate Diagnosis of Acute Myocardial Infarction by Echo

Echo Evaluation of ACS : 

Echo Evaluation of ACS Admitted Patients STEMI: Prognostic information based on ejection fraction If unclear ekg for STEMI, then can obtain bedside echo to look for new wall motion abnormality Shock: Cardiogenic shock can occur after large infarct or right ventricular infarction

Echo Evaluation of ACS : 

Echo Evaluation of ACS Risk Stratification: Stress Echo – using either dobutamine infusion or treadmill exercise to increase heart rate > 85% of max age predicted HR Real time imaging of segmental wall motion abnormalities during stress Location of wall motion abnormality correlates well with involved coronary artery Rest function (at baseline), myocardial viability (at low dose dobutamine) and residual ischemia (peak exercise or maximum dobutamine infusion) If limited echo windows, can give “contrast echo” which uses lipid microbubbles to enhance visualization of endocardial border J Am Coll Cardiol, 1997; 29:254-260

Web Resources : 

Web Resources www.cardiovillage.com Introduction to Echocardiography Stress Echocardiography http://www.med.yale.edu/intmed/cardio/echo_atlas