RT Book, Section
A1 Savage, Rodney W.
A2 Levitov, Alexander B.
A2 Mayo, Paul H.
A2 Slonim, Anthony D.
SR Print(0)
ID 1125015737
T1 ECHOCARDIOGRAPHIC DIAGNOSIS AND MONITORING OF ACUTE MYOCARDIAL INFARCTION AND ASSOCIATED COMPLICATIONS
T2 Critical Care Ultrasonography, 2e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-179352-0
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1125015737
RD 2024/04/19
AB For  the  patient  with  acute  myocardial  infarction  (AMI)  pressing  priorities  exist.  Symptoms  must  be  ameliorated,  lethal  arrhythmias  identified  and  treated,  arteries  opened,  and  complications  identified  and  managed.  In  many  cases,  little  is  needed  beyond  a  targeted  history  and  physical  examination,  12-lead  electrocardiogram  (ECG),  and  simple,  rapid  blood  work  with  prompt  thrombolysis  or  emergency  coronary  arteriography  and  balloon  angioplasty  with  or  without  stenting.  In  such  straightforward  cases,  point-of-care  echocardiography  will  prove  interesting  and  perhaps  helpful  if  potential  complications  are  identified  early.  Such  study,  however,  should  never  delay  needed  efforts  at  reperfusion.  In  other  cases,  the  history  and  physical  examination  may  be  confusing,  or  ECG  and  enzymatic  data  may  be  conflicting,  misleading,  or  delayed.  These  situations  include  (1)  typical  symptoms  but  normal  or  equivocal  laboratory  studies,  (2)  atypical  symptoms  with  equivocal  or  abnormal  laboratory  studies,  (3)  pacemaker  therapy,  (4)  left  bundle  branch  block  (LBBB)  on  ECG,  (5)  presence  of  new  systolic  murmur,  (6)  shock  including  right  ventricular  myocardial  infarction,  (7)  late  clinical  presentation  including  post-myocardial  infarction  (MI)  pericarditis,  (8)  large,  non-Q-wave  MI,  (9)  true  posterior  MI,  and  (10)  suspected  LV  thrombus.  In  these  instances,  point-of-care  ultrasonography  is  not  only  beneficial  but  also  it  may  be  critical  for  improving  the  understanding  of  the  patient’s  condition  and  selecting  appropriate  treatment.