Chest pain echocardiography and ultrasound: Difference between revisions

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{{Chest pain}}
{{Chest pain}}


{{CMG}}; {{AE}}{{Aisha}}  
{{CMG}}; {{AE}} {{Sara.Zand}} {{Aisha}}  


==Overview==
==Overview==
 
[[Transthoracic echocardiography]] ([[TTE]]) can be helpful for diagnosis the causes of acute [[chest pain]] such as acute [[aortic dissection]], [[pericardial effusion]], [[stress cardiomyopathy]], and [[ hypertrophic cardiomyopathy]]. In addition, [[TTE]] does provide information for patients with acute [[chest pain]] and suspected [[ACS]] about left and [[right ventricular function]] and [[regional wall motion abnormalities]]. [[Stress echocardiography]] can be used to define [[ischemia]] severity and for risk stratification purposes when ≥2  contiguous  segments of [[wall motion abnormalities]] in [[coronary  territories]] are visualized.
There are no echocardiography/ultrasound findings associated with [disease name].
 
OR
 
Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


==Echocardiography/Ultrasound==
==Echocardiography/Ultrasound==


===Electrocardiography===
* [[Transthoracic echocardiography]] ([[TTE]]) can be helpful for diagnosis the causes of acute [[chest pain]] such as acute [[aortic dissection]], [[pericardial effusion]], [[stress cardiomyopathy]], and [[ hypertrophic cardiomyopathy]].
An electrocardiogram is very usefel for the diagnosis of several etiologies of chest pain such as;
* In addition, [[TTE]] does provide information for [[patients]] with acute [[chest pain]] and suspected [[ACS]] about left and [[right ventricular function]] and [[regional wall motion abnormalities]].
====Acute coronary syndrome====
* [[Stress echocardiography]] can be used to define [[ischemia]] severity and for risk  stratification purposes when ≥2  contiguous  segments of [[wall motion abnormalities]] in [[coronary  territories]] are visualized.
*A standard 12 lead ECG is recommended in all patients with chest pain within 10 minutes of presentation if acute coronary syndrome is suspected<ref name="pmid3661390">{{cite journal |vauthors=Slater DK, Hlatky MA, Mark DB, Harrell FE, Pryor DB, Califf RM |title=Outcome in suspected acute myocardial infarction with normal or minimally abnormal admission electrocardiographic findings |journal=Am. J. Cardiol. |volume=60 |issue=10 |pages=766–70 |date=October 1987 |pmid=3661390 |doi=10.1016/0002-9149(87)91020-4 |url=}}</ref><ref name="pmid3920520">{{cite journal |vauthors=Brush JE, Brand DA, Acampora D, Chalmer B, Wackers FJ |title=Use of the initial electrocardiogram to predict in-hospital complications of acute myocardial infarction |journal=N. Engl. J. Med. |volume=312 |issue=18 |pages=1137–41 |date=May 1985 |pmid=3920520 |doi=10.1056/NEJM198505023121801 |url=}}</ref>.
*Findings on ECG suggestive of ACS include<ref name="pmid3970650">{{cite journal |vauthors=Lee TH, Cook EF, Weisberg M, Sargent RK, Wilson C, Goldman L |title=Acute chest pain in the emergency room. Identification and examination of low-risk patients |journal=Arch. Intern. Med. |volume=145 |issue=1 |pages=65–9 |date=January 1985 |pmid=3970650 |doi= |url=}}</ref><ref name="O'GaraKushner2013">{{cite journal|last1=O'Gara|first1=Patrick T.|last2=Kushner|first2=Frederick G.|last3=Ascheim|first3=Deborah D.|last4=Casey|first4=Donald E.|last5=Chung|first5=Mina K.|last6=de Lemos|first6=James A.|last7=Ettinger|first7=Steven M.|last8=Fang|first8=James C.|last9=Fesmire|first9=Francis M.|last10=Franklin|first10=Barry A.|last11=Granger|first11=Christopher B.|last12=Krumholz|first12=Harlan M.|last13=Linderbaum|first13=Jane A.|last14=Morrow|first14=David A.|last15=Newby|first15=L. Kristin|last16=Ornato|first16=Joseph P.|last17=Ou|first17=Narith|last18=Radford|first18=Martha J.|last19=Tamis-Holland|first19=Jacqueline E.|last20=Tommaso|first20=Carl L.|last21=Tracy|first21=Cynthia M.|last22=Woo|first22=Y. Joseph|last23=Zhao|first23=David X.|title=2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction|journal=Journal of the American College of Cardiology|volume=61|issue=4|year=2013|pages=e78–e140|issn=07351097|doi=10.1016/j.jacc.2012.11.019}}</ref>, [[ST elevation]], [[ST depression]] and a new [[left bundle branch block]] ([[LBBB]])
*It is important to note that a normal ECG does not rule out the presence of an acute myocardial infarction as ECG can show a hyperacute [[T wave]].<ref name="pmid11992348">{{cite journal |author=Somers MP, Brady WJ, Perron AD, Mattu A |title=The prominant T wave: electrocardiographic differential diagnosis |journal=Am J Emerg Med |volume=20 |issue=3 |pages=243–51 |year=2002 |month=May |pmid=11992348 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735675702921935}}</ref><ref name="ACS_Clin_NA">Smith SW, Whitwam W. "Acute Coronary Syndromes." ''Emerg Med Clin N Am'' 2006; '''24(1)''': 53-89. PMID 16308113</ref> Hyperacute T waves need to be distinguished from the peaked T waves associated with [[hyperkalemia]].<ref name="ECG_Noncardiac">"The clinical value of the ECG in noncardiac conditions." ''Chest'' 2004; '''125(4)''': 1561-76. PMID 15078775</ref> as an early presentation.
*If an initial ECG is nondiagnostic and there is still a high clinical suspicion of an MI, a repeat ECG should be conducted.
*It is helpful to have precious ECGs of a patient to determine if findings observed are new.


==References==
==References==

Latest revision as of 09:30, 18 January 2022

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Aisha Adigun, B.Sc., M.D.[3]

Overview

Transthoracic echocardiography (TTE) can be helpful for diagnosis the causes of acute chest pain such as acute aortic dissection, pericardial effusion, stress cardiomyopathy, and hypertrophic cardiomyopathy. In addition, TTE does provide information for patients with acute chest pain and suspected ACS about left and right ventricular function and regional wall motion abnormalities. Stress echocardiography can be used to define ischemia severity and for risk stratification purposes when ≥2 contiguous segments of wall motion abnormalities in coronary territories are visualized.

Echocardiography/Ultrasound

References

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