Добавил:
Upload Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз: Предмет: Файл:

ECHO 2013 / Acute Coronary Syndromes Echo in the Assessment of Complications

.pdf
Скачиваний:
21
Добавлен:
03.06.2015
Размер:
10.02 Mб
Скачать

State-of-the-Art Echo 2013

Acute Coronary Syndromes II.

Echo in the Assessment of

Complications

Rebecca T. Hahn, MD

Columbia University

No Disclosures

Complications of MI Detected by Echo

Hemodynamic States

Globally reduced LV contractility

Hypovolema

Right ventricular infarction

Ischemic MR

Mechanical Complications

– Papillary muscle rupture

Ventricular septal rupture

Free wall rupture and tamponade

Other

Left ventricular aneurysm

Mural thrombus

Echo Signs of RV Infarct

Primary

RV dilatation

Segmental wall motion abnormalities

Decreased descent of RV base

Secondary

Paradoxical septal motion

Tricuspid regurgitation

Tricuspid papillary muscle rupture

Dilated IVC/Plethora of IVC

Right-to-left IAS bowing

Right-to-left PFO shunt

RV

Infarct

Primary

RV dilatation

Segmental wall motion abnormalities

Decreased descent of RV base

Secondary

Tricuspid regurgitation

Bowing of IAS

RV Infarct

RVD = 4.8 cm

TAPSE =

 

 

12mm

TRV = 3.3 m/s

S’ = 9 cm

RV Infarct

Other Important Views: RV Inflow and Apical 2Chamber

RV Infarct: Subcostal View

Secondary Signs:

Dilated IVC/Plethora of IVC

Dilated IVC/Plethora of IVC

 

Right-to-left IAS bowing

 

Right-to-left PFO shunt

 

Ischemic Mitral Regurgitation

Ischemic MR: valvular incompetence associated with myocardial ischemia or infarction in the absence of primary leaflet or chordal abnormality

Risk Factors

Advanced age

Female gender

– Diabetes

– Prior infarction

Presence or 3-4+ MR associated with up to 24% early and 54% 1-yr mortality

Echo Classification of IMR (type IIIb)

Asymmetric tethering

Symmetric Tethering

 

 

 

 

 

 

 

 

 

 

 

 

Posterior MI

Anterior MI

1.

“Asymmetric” displacement of the

 

posteromedial papillary muscle

1. Global LV remodeling and

 

2.

Deficit in coaptation is due to

apical displacement of both

 

tethering of a portion of P2 and P3

papillary muscles.

 

3. Malcoaptation of the lateral

scallops

Agricola E et al. Eur J Echocardiography 2004 5, 326-334

Quantification of Ischemic/Functional MR

Prognostically-important Cut-off Values

MR

Organic

IMR/FMR

R vol

60 ml

30 ml

ERO

40 mm2

20 mm2

VCW

7 mm

4 mm