EchocardiographyinAcuteChestPain

1、ECHOCARDIOGRAPHY IN CLINICALPRACTICE: GENERAL CONSIDERATIONS Vocabulary：myocardial ,makrdl adj. 心肌的Ischemia skim n. 內(nèi)科 局部缺血transthoracic ,trnzrsk adj. 經(jīng)胸廓的coronary kr()n()r adj. 冠狀的papillary pplr adj. 乳突的；乳頭狀突起的stratification ,strtfken n. 層理；成層pharmacological ,fmkldkl adj. 藥理學(xué)的pulmonary plmn()r adj.

2、 肺的；有肺的；肺狀的embolism emblz()m n. 栓塞；Chest pain may be cardiac or noncardiac in origin.Echocardiography, although useful, should not interferewith the management of patients with myocardialinfarction. It adds little to the diagnosis if ECG and cardiacenzymes are already clearly diagnostic for acutemyo

3、cardial infarction (Table 8). When doubt exists,e.g., nondiagnostic ECG changes, or when other causesof chest pain are entertained, transthoracic echocardiographycan be of value. Echocardiography in Acute Chest Pain and Myocardial IschemiaNew regional wall motionabnormalities appearing in previously

4、 normal ventricularsegments support the diagnosis of acute myocardialischemia and may precede changes in the ECG.Likewise, other findings may argue against acute coronarysyndrome, including pericardial effusion (asmight be seen in pericarditis), and right ventricularenlargement (as might be seen in

5、pulmonaryembolism).Although new regional wall motion abnormalitiescan be highly suggestive of acute ischemia orinfarction, this diagnosis can be considerably morechallenging in patients with prior history of myocardialinfarction or abnormal regional wall motion.Following myocardial infarction, echoc

6、ardiographycan have substantial value (Chapter 7). Early and latepost-myocardial infarction complications, e.g., ventricularseptal defect or papillary muscle rupture can bediagnosed with echocardiography. In the postinfarctionperiod, echocardiography can assist with the diagnosis,risk assessment, an

7、d prognosis (Table 8).In chronic myocardial ischemia, echocardiographycan provide added information on disease severity andrisk stratification that impacts further clinical management(Tables 8 and 9; Chapter 8). Where indicated,exercise or pharmacological stress echocardiographyare useful adjuncts i

8、n assessing global and regional systolicfunction as well as myocardial contractile reserve.PULMONARY EMBOLISMAlthough less sensitive and specific than ventilationperfusionscans and pulmonary angiography in acute pulmonary embolism, echocardiography has value indetecting right ventricular enlargement

9、 and dysfunctionthat result from the acute increase in pulmonaryvascular resistance and right ventricular afterload.Echocardiography is also helpful in distinguishing pulmonaryembolism from other causes of acute chestpain, e.g., acute myocardial infarction, acute pericarditis,or cardiac tamponade. Direct visualization of alarge pul