[Role of echocardiography in acute coronary syndrome]

This article reviews the diagnostic and clinical role of echocardiography in acute coronary syndrome (ACS). The diagnosis of ACS is based on the medical history data, ECG and cardiac enzymes. Echocardiography is an accurate, inexpensive, rapid and noninvasive test, which has a diagnostic and prognostic value and detects complications in ACS. Echocardiography can evaluate damaged myocardium and myocardium which is not involved with acute ischemia, and therefore it is recommended for establishing diagnosis in patients with chest pain and clinical evidence of structural heart damage or suspected aortic dissection, for evaluation of chest pain in patients with suspected acute myocardial ischemia with unresponsive hemodynamic instability or when other methods are undiagnostic. By localizing and quantifying segmental wall motion abnormalities, echocardiography can identify the location and extent of the ischemia. It is also the mainstay of diagnosis and evaluation of mechanical complications of myocardial infarction that include ischemic mitral and tricuspid regurgitation, ventricular and papillary muscle rupture, LV thrombi, left ventricular aneurysms and pseudoaneurysms. Echocardiography is also used for risk stratification and prognosis after myocardial infarction by assessing systolic and diastolic left ventricular function. New echocardiographic methods such as stress echocardiography and myocardial contrast echocardiography have emerged and contribute to an accurate diagnosis of ACS and better evaluation of reperfusion therapy. In emergency room and coronary care units, echocardiography as a noninvasive and inexpensive method in comparison with other established methods has significant utility in the diagnosis and management of ACS patients.