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The “bread and butter” of adult cardiology is coronary artery disease.


“Look locally—interpret globally.”

  • Regional left ventricular wall motion analysis is the cornerstone of echocardiographic imaging in coronary artery disease.

  • Regional left ventricular wall motion abnormalities are indicators of myocardial ischemia during a stress test.

  • Regional left ventricular wall motion abnormalities are present in acute myocardial infarction.

  • In addition to localizing myocardial infarction, echocardiography serves to diagnose complications of infarction.

  • Anterior myocardial infarction can be complicated by an apical left ventricular aneurysm.

  • Inferior myocardial infarction can be complicated by mitral regurgitation.

  • Pulmonary edema and a new murmur, in a patient with myocardial infarction, may indicate either papillary muscle rupture or ventricular septal rupture. Echocardiography helps to identify these critical complications.

  • Right ventricular infarction is an important complication of inferior myocardial infarction, and echocardiography is used for diagnosis and subsequent management.

  • The electrocardiogram is utilized in conjunction with the echocardiogram in all patients with coronary artery disease.

  • Basic roles of echocardiography:

    • - Regional left ventricular wall motion analysis.

    • - Stress testing for myocardial ischemia.

    • - Complications of myocardial infarction.

    • - Differential diagnosis of chest pain.


  • The decision for initiating treatment in acute ST-elevation myocardial infarction is made quickly and is based on the ECG and cardiac symptoms.

  • The echocardiogram serves to help exclude alternative diagnoses for the cause of chest pain, such as aortic dissection or pericarditis.

  • The echocardiogram can help diagnose the following complications of myocardial infarction:

    • - Apical left ventricular aneurysm in anterior myocardial infarction.

    • - Apical left ventricular thrombus.

    • - Basal inferior aneurysm.

    • - Mitral regurgitation and/or papillary muscle rupture.

    • - Ventricular septal rupture.

    • - Left ventricular pseudoaneurysm (ventricular rupture into the pericardial space).

    • - Right ventricular infarction.


  • Marangelli V, Cacciavillani L, Pontarollo S, et al. Images in cardiovascular medicine. Three-dimensional imaging in rupture of papillary muscle after acute myocardial infarction. Circulation. 2005;111:e385–e387.


  • The role of echocardiography in coronary artery disease centers on regional wall motion analysis of the left ventricle.

  • The ECG of myocardial infarction is complemented by regional left ventricular wall motion on echo to help localize and to define extent of infarction.

  • Both the ECG and the echocardiogram serve to localize the affected territory in coronary artery disease.

  • In contrast, the ECGs of pericarditis and myocarditis show diffuse ST-segment abnormalities.

  • The echocardiogram helps to distinguish between myocarditis and pericarditis.

  • There should be diffuse left ventricular motion abnormalities, as well as left ventricular cavity dilatation, on the echocardiogram of patients with myocarditis.

  • There should be a pericardial effusion on the echocardiogram of patients with pericarditis.

  • Caution: Pericarditis and myocarditis are not always mutually exclusive. Elevated troponins in pericarditis may indicate coexisting myocarditis.


  • Wang ...

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