Noninvasive assessment of patients with ischemic heart disease

The diagnosis of acute myocardial infarction can be strengthened in selected patients by the use of pyrophosphate scanning. Such scans may provide useful information about the relative size of myocardial infarction. Radionuclide angiography and two-dimensional echocardiography are useful for determining the extent of myocardial dysfunction following infarction. Two-dimensional echocardiography is especially suitable for use in the acute care setting and can provide excellent anatomic images to help diagnose the mechanical complications of infarction, such as mural thrombus formation and ventricular septal rupture. Therefore, many investigators believe that two-dimensional echocardiography is indicated for evaluating every myocardial infarction patient. The predischarge assessment of the postinfarction patient is critical for planning a rational rehabilitation program. Uncomplicated patients should have low level treadmill exercise tests to detect unsuspected problems which indicate a poor prognosis, such as angina pectoris. Continuous ambulatory electrocardiograms recordings are useful for excluding prognostically important, but asymptomatic, dysrhythmias. Two-dimensional echocardiography and radionuclide angiography also are helpful for assessing the extent of myocardial dysfunction and defining left ventricular aneurysms and mural thrombi.