[Acute myocardial ischemia: ECG or echocardiography? Considerations on a clinical case].
We present a clinical case and a review of the literature on the usefulness of two-dimensional echocardiography for the diagnosis of acute myocardial ischemia in patients presenting with chest pain but without diagnostic electrocardiographic changes. The case refers to a patient admitted a few hours after an episode of prolonged chest pain without diagnostic electrocardiographic changes, but with a severe wall motion abnormality assessed by two-dimensional echocardiogram. The electrocardiogram obtained 24 hours after admission showed giant negative T waves in the anterior chest leads when the patient was asymptomatic and the echocardiogram showed disappearance of wall motion abnormalities. Coronary angiography demonstrated a thrombotic occlusion of the left anterior descending coronary artery, that was treated by transluminal angioplasty. The considerations refer to the following points: 1) a substantial portion of patients with chest pain examined in the emergency room has initially a normal or non-diagnostic electrocardiogram; 2) in these patients two-dimensional echocardiography provides a highly sensitive and specific noninvasive tool for the establishment of the correct diagnosis of acute myocardial ischemia when a severe wall motion abnormality is shown; 3) if successive amelioration of regional myocardial dysfunction is assessed, this was probably due to stunned myocardium; 4) it is probably not correct to consider T wave inversion as the electrocardiographic equivalent of myocardial stunning, as the two phenomena are not chronologically correlated.
Albiero
R
R
Servizio Di Cardiologia, Ospedale Civile Maggiore, Verona.
Variola
A
A
Dander
B
B
Buonanno
C
C
D000208:Acute Disease; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*