Role of echocardiography in the emergency department for identifying patients with myocardial infarction and ischemia

Echocardiography is a valuable, noninvasive diagnostic tool that can provide information on systolic function and valvular abnormalities and can provide alternative explanations for causes of chest pain. Experimental as well as clinical studies have shown that wall motion abnormalities have a high sensitivity for predicting myocardial infarction. More recent studies, performed in, the emergency department on patients evaluated for myocardial ischemia, have reported similar results. An important aspect is that necrosis is not necessary to cause walt motion abnormalities; therefore, echocardiography can also be used to identify patients with ischemia without infarction. Importantly, sensitivity is significantly higher than that for electrocardiography and is comparable to that for myocardial perfusion imaging. Newer developments, such as digital transmission over telephone lines, may lead to more widespread routine use in the emergency department. Acute emergency department echocardiography appears to be a promising tool when used in the evaluation of patients with chest pain.