Echocardiographic diagnosis of mechanical complications in acute myocardial infarction

Myocardial infarction occurs with an incidence of approximately 1.5 million cases annually in the United States. Mortality remains at about 12% despite recent advances in medical and interventional therapies. A significant proportion of deaths is due to mechanical complications following infarction. These complications include rupture of the ventricular free wall, septum and papillary muscles. Collectively, they are potentially treatable. However, they require prompt diagnosis and urgent surgical intervention. Traditional measures in the evaluation of these patients include invasive tests such as right heart catheterisation, coronary angiography and contrast left ventriculography, which may be time-consuming and are not without untoward effects. The purpose of this review is to examine the role of echocardiography as an adjunct in the diagnosis of mechanical complications in acute myocardial infarction. Echocardiography is particularly well suited for this purpose as it is safe, performed rapidly and is capable of providing reliable information regarding the presence and location of transmural rupture, interventricular shunts and the evaluation of mitral regurgitation. In addition, echocardiography is capable of assessing overall left ventricular function and regional wall motion abnormalities.