Advertisement

Diagnosis of acute coronary occlusion in patients with non–STEMI by point-of-care echocardiography with speckle tracking

Published:February 12, 2016DOI:https://doi.org/10.1016/j.ajem.2016.02.017
      Approximately 25% of patients with acute coronary occlusion present without diagnostic evidence of ST elevation on electrocardiogram. Traditionally, individuals that fall into this category have been detected by subsequent elevation of cardiac markers and are diagnosed with non–ST-elevation myocardial infarction. Early detection and intervention of these individuals lead to lower 6-month mortality; however, there has not been a good way to detect these individuals reliably. We report a case of a man presenting to the emergency department (ED) with a non–ST-elevation myocardial infarction who was found to have acute coronary occlusion detected by speckle tracking echocardiography performed by an emergency physician. This diagnosis led to early percutaneous intervention. This case highlights a novel use of ultrasound in the ED for detection of acute coronary occlusion when an electrocardiogram is nondiagnostic.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wang T.
        • Zhang M.
        • Fu Y.
        • Armstrong P.W.
        • Newby L.K.
        • Gibson C.M.
        • et al.
        Incidence, distribution, and prognostic impact of occluded culprit arteries among patients with non–ST-elevation acute coronary syndromes undergoing diagnostic angiography.
        Am Heart J. 2009; 157: 716-723
        • From A.M.
        • Best P.J.
        • Lennon R.J.
        • Rival C.S.
        • Prasad A.
        • et al.
        Acute myocardial infarction due to left circumflex artery occlusion and significance of ST-segment elevation.
        Am J Cardiol. 2010; 106: 1081-1085
        • Pride Y.B.
        • Tung P.
        • Mohanavelu S.
        • Zorkun C.
        • Wiviott S.D.
        • Altman E.M.
        • et al.
        Angiographic and clinical outcomes among patients with acute coronary syndromes presenting with isolated anterior ST-segment depression: a TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis In Myocardial Infarction 38) substudy.
        J Am Coll Cardiol Intv. 2010; 3: 806-811
        • Martí D.
        • Mestre J.L.
        • Salido L.
        • Esteban M.J.
        • Casas E.
        • Pey J.
        • et al.
        Incidence, angiographic features and outcomes of patients presenting with subtle ST-elevation myocardial infarction.
        Am Heart J. 2014; 168: 884-890
        • Amsterdam E.A.
        • Wenger N.K.
        • Brindis R.G.
        • Casey Jr., D.E.
        • Ganiats T.G.
        • Holmes Jr., D.R.
        • et al.
        2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2014; 64: 139-228
        • Hamm C.W.
        • Bassand J.P.
        • Agewall S.
        • Bax J.
        • Boersma E.
        • Bueno H.
        • et al.
        ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).
        Eur Heart J. 2011; 32: 2999-3054
        • Sjøli B.
        • Ørn S.
        • Grenne B.
        • Ihlen H.
        • Edvardsen T.
        • Brunvand H.
        Diagnostic capability and reproducibility of strain by Doppler and by speckle tracking in patients with acute myocardial infarction.
        J Am Coll Cardiol Img. 2009; 2: 24-33
        • O'Gara P.T.
        • Kushner F.G.
        • Ascheim D.D.
        • Casey Jr., D.E.
        • Chung M.K.
        • de Lemos J.A.
        • et al.
        2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2013; 127: e362-e425
        • Montalescot G.
        • Dallongeville J.
        • Van Belle E.
        • Rouanet S.
        • Baulac C.
        • Degrandsart A.
        • et al.
        STEMI and NSTEMI: are they so different? 1 year outcomes in acute myocardial infarction as defined by the ESC/ACC definition (the OPERA registry).
        Eur Heart J. 2007; 28: 1409-1417
        • Grenne B.
        • Eek C.
        • Sjøli B.
        • Dahlslett T.
        • Uchto M.
        • Hol P.K.
        • et al.
        Acute coronary occlusion in non–ST-elevation acute coronary syndrome: outcome and early identification by strain echocardiography.
        Heart. 2010; 96: 1550-1556
        • Eek C.
        • Grenne B.
        • Brunvand H.
        • Aakhus S.
        • Endresen K.
        • Smiseth O.A.
        • et al.
        Strain echocardiography predicts acute coronary occlusion in patients with non–ST-segment elevation acute coronary syndrome.
        Eur J Echocardiogr. 2010; 11: 501-508
        • Kataoka A.
        • Funabashi N.
        • Yajima R.
        • Takahashi M.
        • Takahashi A.
        • Saito M.
        • et al.
        Differentiation of pseudodyskinesis of inferior left ventricular wall from inferior myocardial infarction by assessment of regional myocardial strain using two-dimensional speckle tracking echocardiography.
        Int J Cardiol. 2011; 152: 362-368
        • Dandel M.
        • Lehmkuhl H.
        • Knosalla C.
        • Suramelashvili N.
        • Hetzer R.
        • et al.
        Strain and strain rate imaging by echocardiography—basic concepts and clinical applicability.
        Curr Cardiol Rev. 2009; 5: 133-148
        • Ammar K.A.
        • Paterick T.E.
        • Khandheria B.K.
        • Jan M.F.
        • Kramer C.
        • Umland M.M.
        • et al.
        Myocardial mechanics: understanding and applying three-dimensional speckle tracking echocardiography in clinical practice.
        Echocardiography. 2012; 29: 861-872
        • Edvardsen T.
        • Skulstad H.
        • Aakhus S.
        • Urheim S.
        • Ihlen H.
        Regional myocardial systolic function during acute myocardial ischemia assessed by strain Doppler echocardiography.
        J Am Coll Cardiol. 2001; 37: 726-730
        • Amundsen B.H.
        • Helle-Valle T.
        • Edvardsen T.
        • Torp H.
        • Crosby J.
        • Lyseggen E.
        • et al.
        Noninvasive myocardial strain measurement by speckle tracking echocardiography.
        J Am Coll Cardiol. 2006; 47: 789-793
        • Urheim S.
        • Edvardsen T.
        • Torp H.
        • Angelsen B.
        • Smiseth O.A.
        Myocardial strain by Doppler echocardiography: validation of a new method to quantify regional myocardial function.
        Circulation. 2000; 102: 1158-1164