Ischmic Heart Disease Myocardial Infarction Current clinical practice

Ischmic Heart Disease Myocardial Infarction

Current clinical practice guidelines of the ACC/AHA Curr Opin Cardiol 2008;23:613–619

Acute Coronary Syndrome Electrocardiographic changes are often nonspecific in more than 50% of patients with chest pain. Cardiac biomarkers take hours from symptoms onset to exceed the normal range.

Role of Echocardiography in AMI Anatomical, functional and hemodynamic information Diagnosis and exclusion of AMI in patients with chest pain and non-diagnostic ECG findings Estimation of the amount of myocardium at risk and final infarct size after reperfusion therapy

Role of Echocardiography in AMI 3. Evaluation of unstable hemodynamics 4. Detection of infarct complications 5. Evaluation of myocardial viability 6. Risk stratification

Wall motion abnormality in AMI Compensatory hyperkinesis RWMA at other area : Multi vessel involvement Wall Motion Score Index

Acute Myocardial Infarction-LAD

Acute Myocardial Infarction-LAD

Acute Myocardial Infarction-LAD

Acute Myocardial Infarction-LCX

Acute Myocardial Infarction-LCX

Acute Myocardial Infarction-LCX

Acute Myocardial Infarction-RCA

Acute Myocardial Infarction-RCA

Complications of Acute Myocardial Infarction Pericardial effusion, LV thrombus, Aneurysm, RV involvement

Ventricular Septal Rupture Hypotension, Systolic murmur Ventricular septal defect with left to right shunt by echo

Acute Myocardial Infarction Posteroinferior myocardial infarction Contrast echo study Free wall rupture and pseudoaneurysm was observed. Contrast echo for pericardial leakage was done.

Acute Myocardial Infarction Anterior wall myocardial infarction Large LV apical thrombus

Right Ventricular Infarction

Right Ventricular Infarction

Dobutamine stress echo Low Dose Dobutamine Echo Baseline Subtotal stenosis of proximal LAD

Stenting and f/up Echo in 10 months later LAD stenting

Patients with Chest Pain

Acute Pulmonary Embolism D-shaped LV Thrombi

Hypertrophic Cardiomyopathy No identified disease to cause hypertrophy T-inversion on ECG Severe ventricular hypertrophy No RWMA

Acute Pericarditis Pericardial effusion No RWMA Chest pain, elevated cardiac enzymes, and ST elevation on ECG Respiratory variation of mitral inflow High e’ velocity

Aortic Dissection

Tako-tsubo Cardiomyopathy Apical Ballooning Syndrome First described in Japan The ballooning configuration of the LV is similar to a tako-tsubo (Japanese octopus trap)

Modified Mayo Clinic Criteria of stress induced cardiomyopathy transient hypokinesis, akinesis, or dyskinesis in the LV mid segments with or without apical involvement; RWMA that extend beyond a single epicardial vascular distribution; and frequently, but not always, a stressful trigger (2) the absence of obstructive coronary disease or angiographic evidence of acute plaque rupture

Modified Mayo Clinic Criteria of stress induced cardiomyopathy (3) new ECG abnormalities (ST-segment elevation and/or T-wave inversion) or modest elevation in cardiac troponin (4) the absence of pheochromocytoma and myocarditis ***Patients were assigned this diagnosis when they satisfied all these criteria.

Stress induced cardiomyopathy

CAG with F/U echocardiogram Follow up Echocardiogrpahy