ECHO 2013 / Echocardiography in Acute Coronary Syndromes Management and Risk Assessment

Multifocal pneumonia due to aspiration superimposed ACS ????

•Echo

–Trivial anterior pericardial effusion

–Subtle inferior WMA

•No progression of ECG

•Trop remains elevated > four days later

–No typical ACS curve

•Myo-pericarditis ?

–Confirmed on cMR

ACS and hypotension

•Differential diagnosis

–Poor LV function vs. Mechanical complications

•Prognostic echo markers

–LVEF, MR

•important across all age groups

Not all WMA = ACS

•Stress cardiomyopathy (reversible)

–Takotsubo

•Myopericarditis (reversible)

•Old MI (not reversible)

•Chagas cardiomyopathy

What do the appropriate use criteria say ?

Douglas et al, JASE 2011;24:229-64 and JACC 2011;57:1126-66

•Myocardial Ischemia / Infarction with TTE

–Acute CP with suspected MI and non-diagnostic ECG when a resting echo can be performed during pain = APPROPRIATE

–Evaluation of a patient without chest pain but with other features of an ischemic equivalent or laboratory markers indicative of ongoing MI = APPROPRIATE

–Suspected complication of myocardial ischemia /infarction = APPROPRIATE

•Evaluation of Ventricular Function after ACS with TTE

–Initial evaluation of ventricular function following ACS = APPROPRIATE

–Re-evaluation of ventricular function following ACS during recovery phase when results will guide therapy = APPROPRIATE

Echocardiography in Acute

Coronary Syndromes:

should we image ? SOMETIMES

•To make the correct diagnosis

–Uninterpretable or non diagnostic ECG

–Confusing presentation

•Sorting out the differential diagnosis

–Immediate – no need to wait for the markers

•Assessing prognosis

–Early or later

•When things turn sour

–Assessing complications of CAD