Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

Detect Cardiac Regional Wall Motion Abnormalities by Point-of-Care Echocardiography

By Brian Johnson, MD, MPH, Emily Lovallo, MD, Oron Frenkel, MD, and Arun Nagdev, MD | on February 11, 2015 | 0 Comment
Sound Advice
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version

More than 6 million emergency department visits a year in the United States are for chest pain.1 While there are approximately 1.1 million hospitalizations a year for acute coronary syndrome (ACS) in the United States, only approximately 30 percent of cases are ST-elevation myocardial infarctions.2 The remaining 70 percent are diagnosed with unstable angina (UA) or non–ST-elevation myocardial infarction (NSTEMI). Risk stratification of chest pain patients with concern for ACS is of high concern in the emergency department. The American Heart Association (AHA) current guidelines recommend prompt management and possibly invasive strategies for patients with UA and NSTEMI who present with high-risk features.3 Often in the ED setting, chest pain patients have a nondiagnostic electrocardiogram (ECG), and initial cardiac biomarkers can be negative even with significant coronary artery occlusion.

You Might Also Like
  • Introducing the CASA Exam: A New Protocol to Guide Point-Of-Care Ultrasound in Cardiac Arrest
  • Fast Angiography Not Helpful for Unconscious Cardiac Arrest Patients Without STEMI
  • Bedside Ultrasound Assessment of Left Ventricular Function
Explore This Issue
ACEP Now: Vol 34 – No 02 – February 2015

Novice sonographers may have difficulty obtaining clear views and should not base decisions on suboptimal imaging. Even for the experienced ED sonographer, differentiating between new and old RMWAs can be extremely challenging.

Investigation of regional wall motion abnormalities (RWMAs) is a Class I recommendation by the AHA in the hands of trained echocardiogram technicians.4 The goal is to identify patients with RWMAs likely representing a significant occult coronary artery thrombosis not evident by symptoms, ECG, or initial cardiac biomarkers that could then benefit from an invasive intervention. Previous studies suggest that if a RWMA is present, a large area of myocardium is at risk for death.5–7 Initial studies have shown good sensitivity and specificity of the identification of RWMAs for coronary ischemia in the ED setting.8,9 Most of these studies were performed by trained ECG technicians or cardiologists. However, several articles recently described emergency physicians of various levels of training being capable of identifying RWMAs.10,11 A case series described three cases in which emergency physicians identified RWMAs in patients with equivocal ECGs; all the cases went to cardiac catheterization partly based on the point-of-care echocardiography (POC echo) detecting RWMA and were found to have significant single-vessel coronary disease requiring intervention.12

Appropriate probe positioning and corresponding ultrasound image of A) PLAX, B) PSAX, and C) A4C.

(click for larger image) Figure 1: Appropriate probe positioning and corresponding ultrasound image of A) PLAX, B) PSAX, and C) A4C.

Clinical Indications for Performing POC Echo for RWMAs

Evaluation for RWMAs should promptly occur when the emergency physician has a high concern for UA or NSTEMI by history and physical examination with an equivocal ECG for cardiac ischemia.

Anatomy

For simplicity, the traditional 17-wall motion segment identification on ECG has been

Pages: 1 2 3 4 | Single Page

Topics: Cardiac CareCardiac Regional Wall Motion AbnormalitiesCardiovascularCrticial CareEmergency MedicineEmergency PhysicianProcedures and SkillsUltrasound and Imaging

Related

  • EM Runs in the Family

    February 26, 2025 - 0 Comment
  • Peripartum Cardiovascular Disease Is Rare, But Serious

    December 31, 2024 - 0 Comment
  • Mild COVID-19 Infection Unlikely To Cause Lasting Heart Damage

    May 20, 2021 - 0 Comment

Current Issue

ACEP Now May 03

Read More

No Responses to “Detect Cardiac Regional Wall Motion Abnormalities by Point-of-Care Echocardiography”

Leave a Reply Cancel Reply

Your email address will not be published. Required fields are marked *


*
*

Wiley
  • Home
  • About Us
  • Contact Us
  • Privacy
  • Terms of Use
  • Advertise
  • Cookie Preferences
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603