Mild LV-wall disturbance detected by speckle-pattern
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Mild LV-wall disturbance detected by speckle-pattern
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Added: 09-03-2012
Runtime: 0m 14s
Views: 6014
Comments: 4 Current Rating:
(1 Votes)
Runtime: 0m 14s
Views: 6014
Comments: 4 Current Rating:
(1 Votes)
Description
About 45 y old patient with the typical clinical afflictions of acute coronary syndrom. in TTE I couldn´t see a LV-wall-motion-disorder. In Speckle-tracking/-pattern study I found a mild LV-wall-motion-disturbance. Troponin was positive. In coronary study we found a high-grade stenosis of RIVA compatible with the results of speckle-pattern-study. What do you think? Does anybody have any experiences with that kind of stuff? Is it a suitable kind of study?
About 45 y old patient with the typical clinical afflictions of acute coronary syndrom. in TTE I couldn´t see a LV-wall-motion-disorder. In Speckle-tracking/-pattern study I found a mild LV-wall-motion-disturbance. Troponin was positive. In coronary study we found a high-grade stenosis of RIVA compatible with the results of speckle-pattern-study. What do you think? Does anybody have any experiences with that kind of stuff? Is it a suitable kind of study?
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I see the group and we can discuss
with videos but can not
create topics. In that case we must create a blog... what do you
think?
Hello Jörg.
Well, take care, RIVA is ramus intermedius
artery (sometimes present like third branch in left coronary trunk,
so, in this time we have LAD, Cx and RIVA)
With respect to
early finding...trop or echo? if you consider kinetics of troponin
(begin in 12 hours and peak in two days)always echo have early
findings...and if you think in other way...if patient have no
biomarkers elevation...y mean...myocardial ischemia but no
infarction...echo made diagnosis certainly!
The clip is
excelent my friend.!
Best
Pablo
Hello my friend!
/>
Thank you very much for comment. This clip was
one of my first tentative steps with echocardiographic speckle-pattern
study. In this case I was very glad, that the speckle-pattern does fit
to the underlaying coronary result (high-grade stenosis of RIVA with
disturbance of anterior LV-wall, the cardiac service area of RIVA).
Aaah... I'm very sorry. I used the common german nomenclature:
RIVA=LAD.
ECG showed some non-specific signs like lowering of
ST-line and negative T in V2-V5. I saw this anterior LV-movement
disorder before Troponine was positive (only the second test of
troponin was positive).
But I think, that this speckle-pattern
study is very, very dependent on the skills and experiences of the
investigator. And I don't have such experiences, unfortunately.
I
find that method very interesting: is it possible to see the wall
movement disorder as a sign for myocardial ischaemia BEFORE blood test
become positive?
Thanks a lot once more for comment!!!!!
Besides: do you have any idea how to create a interesting
topic for dicussion in the echodynamic-group? I thought that group
could be a good plattform for discussion and sharing thoughts, but
unfortunately I haven't created a topic yet because I don't know how I
can do that.
Best wishes,
Jörg.
Impressive case Jörg and excelent clip. Congratulations!
/>And EKG?
/>Best
Speckle-traking is very sensitive to detect
subtle changes in contractility...but, unfortunately, i don´t have it
(with tdi I am happy ahaha).
And with the RIVA I don´t
have experience (altough is the more frequent coronary anatomy
variant, in my Hospital the cath-lab (they made 10 studies divided in
two days by week, they are not 24 hours in hospital and they came from
outside) don´t report so much this anomaly)
And, what to do with
this high-grade stenosis? I don´t know but if the region irrigated is
important (like in this case) I think it must be reopened.
Pablo