Chapter 2: Echocardiography in acute myocardial infarction

Echocardiography is valuable in all patients with acute myocardial infarction (MI) for diagnosis, functional assessment, detection of complications, and/or prognosis.
Echocardiography may miss small, nontransmural infarctions.
Regional wall motion abnormality associated with preserved wall thickness in diastole, which is an echo- cardiographic hallmark of acute MI, may be caused by conditions other than infarction (e.g., ischemia or acute myocarditis).
The value of echocardiography as a diagnostic tool is highest in patients with acute coronary syndrome with atypical clinical presentation, nondiagnostic electrocardiogram, and/or normal or only slightly increased cardiac enzymes.
Measuring ejection fraction in the acute phase of the infarction may not reflect true functional loss, although a low postinfarction ejection fraction is a strong predictor of poor outcome.
Dyssynergic myocardial regions may be viable and may have the potential of functional recovery. Viability can be assessed early by echocardiography-based techniques.
Initial left ventricular volumes, wall motion score index, infarct zone viability, and diastolic filling carry important prognostic information.
Echocardiographic examination must not induce unnecessary delays in triage of patients to reperfusion therapy.

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