Two-dimensional and Doppler echocardiography in acute myocardial infarction and its complications

Two-dimensional echocardiography is an outstanding and unique bedside diagnostic and prognostic method for cardiologists facing the early diagnosis and complications of acute myocardial infarction. Its advantages are safety, rapidity, portability, and relatively low costs. It is suitable for evaluation of global and, more importantly, segmental myocardial function. Segmental wall motion analysis reliably detects, localizes, and estimates the extent of myocardial infarction in the first hours after onset of symptoms. In addition, it is the most sensitive method to diagnose right ventricular infarction and provides information predictive of early and late postinfarct complications. In postinfarct hemodynamic deterioration two-dimensional echocardiography allows one to distinguish primary pump failure from mechanical complications as: rupture of the free wall, of the ventricular septum or mitral valve dysfunction. In the subacute stage complications as ventricular (pseudo) aneurysm and thrombus may be diagnosed by two-dimensional echocardiography. Combined Doppler echocardiographic examination provides reliable information about the presence of insufficiency or shunting. Thus, echocardiography has become indispensable at the coronary care unit as it provides a complete picture of cardiac structure and function making it superior to most other methods in the clinical situation of an acute myocardial infarction with such a volatile and unpredictable course. This is an argument to house an echo/Doppler instrument in the coronary care unit.