EchoBridgeMD Pearl #9: Regional Wall Motion Abnormalities for Detecting Acute Myocardial Ischemia

A normal or non-diagnostic ECG does not exclude acute coronary occlusion.

In patients with a concerning history and physical examination, bedside echocardiography can identify regional wall motion abnormalities (RWMAs) that may be present before ECG changes or biomarker elevation.

In this patient with chest pain, notice how the left ventricular posterior wall (perfused by the right coronary artery) is akinetic, whereas the septal wall (perfused by the left anterior descending coronary artery) demonstrates normal inward excursion.

Reference:

📖 Croft PE, et al. WAMAMI: emergency physicians can accurately identify wall motion abnormalities in acute myocardial infarction. Am J Emerg Med. 2019.

https://pubmed.ncbi.nlm.nih.gov/30987914/

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