Echocardiographic Findings in Acute MI Wall Motion Abnormalities Coronary Artery Territories The Role of Echo in Evaluating Chest Pain Indications for Transthoracic Echocardiography During and After MI Subacute Complications Case Presentation (continued) Pseudoaneurysm Free Wall Rupture Left Ventricular Thrombus
Pericardial Complications: Infarct-Related Acute Pericarditis, Tamponade Chronic Implications Suggested Reading case presentation
An 80-yr-old male with a history of hypertension who presented with acute onset of chest pain associated with mild shortness of breath and palpitations, lasting a total of 20 min by the time he was transported to the hospital. On physical exam he appeared uncomfortable, diaphoretic, tachycardic, and with a blood pressure of 90/60 mmHg. Lungs were clear to auscultation, and a cardiac exam revealed an S3 without murmurs or rub. His electrocardiogram (ECG) displayed 5-mm ST elevations in leads V1-5 with lesser elevations in the inferior leads, and the initial chest X-ray showed clear lungs. Cardiac enzymes were sent, and the patient started on aspirin and heparin in addition to lytic therapy with Retavase®.
The patient was ultimately transferred to a tertiary care institution for cardiac catheterization. He became chest pain-free en route, but catheterization showed a tight proximal left anterior descending (LAD) stenosis, which was balloon-angioplastied and stented. However, only partial flow was noted at the end of the procedure. Left ventriculogram was not done because of an elevated creatinine level, and instead a transthoracic echocardiography (TTE) was performed.
Figure 1A,B (please see companion DVD for corresponding video) shows the typical immediate sequelae of an acute anteroseptal myocardial infarction (MI). Note: (1) left ventricular hypertrophy, as indicated by wall thicknesses of more than 11 mm in diastole, indicative of long-standing hypertension; (2) normal sized left ventricle (LV) (end-diastolic diameter <5.6 cm at the base in parasternal long axis), but decreased shortening fraction (increased end-systolic diameter >4.0 cm); (3) absence of myocardial thickening in systole (akinesis) of the anterior and anteroseptal wall from midventricle to apex. In an ongoing untreated MI involving only one coronary artery territory, the other territories with preserved coronary blood supply will often be hyperdynamic.
From: Contemporary Cardiology: Essential Echocardiography: A Practical Handbook With DVD Edited by: S. D. Solomon © Humana Press, Totowa, NJ
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