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What do you think the echocardiogram shows? This was a point of care ultrasound, not a bubble contrast echo. One would not expect wall motion to recover so quickly after stenting, so this is good evidence that the POCUS echo was indeed accurate. Cath lab activated Dual antiplatelet therapy and heparin given. NTG drip started.
A male in his 40's who had been discharged 6 hours prior after stenting of an inferoposterior STEMI had sudden severe SOB at home 2 hours prior to calling 911. He had diffuse crackles on exam and B-lines on chest ultrasound, and chest x-ray also confirmed pulmonary edema. He had no chest pain.
Although he had a normal echocardiogram and stress test a year ago at a different hospital, due to his symptoms and intermediate-high risk probability of coronary artery disease (CAD), the decision was made to proceed with a cardiac catheterization using a trans-radial approach with a horizontal sweep technique.
The patient was thought to have low likelihood of ACS, and cardiology recommended repeat troponin, urine drug testing, and echocardiogram. Bedside echocardiogram showed hypokinesis of the mid to distal anterior wall and apex. Fortunately, this operator used intravascular ultrasound (IVUS). Initial hscTnI was 10 ng/L (ref. <14).
Two thirds of MINOCA cases are due to atherosclerotic causes One way to prove the diagnosis in this case would have been with intravascular imaging such as optical coherence tomography (OCT) or intravascular ultrasound (IVUS). His echocardiogram showed normal wall motion. Fortunately, that is exactly what happened.
So today i wanted to talk to you about what each heart test tells us about these different aspects of heart disease Tests that tell you about the heart as a pump The most commonly used test to assess the heart as a pump is an echocardiogram. This is an ultrasound (a bit like the type that we use on pregnant women to look at the baby).
Here are a couple shots with strain, or "speckle tracking" on ED Echo: To, me these look like anterior wall motion abnormality, but I showed them to one of our ultrasound fellows who is very interested in this. It was stented. They read it as normal. She said: This is a tough one. Learning Points : 1. Use the 4-variable formula!!
After rethinking the case, he remained concerned about ACS and subsequently performed a point-of-care ultrasound in order to evaluate for regional wall motion abnormality. He was successfully treated with one drug eluting stent. A second troponin had been drawn 3 hours after arrival and was again less than 0.30ng/mL. Do NOT use them.
His ED cardiac ultrasound (which is not at all ideal for detecting wall motion abnormalities, and is also very operator dependent for this finding) was significant for depressed global EF. I think a good start would be a posterior EKG and a high quality contrast echocardiogram read by an expert. What would you do in this scenario?
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