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Acute Coronary Syndrome (ACS)

  • Harald Becher
  • Andreas Helfen
Chapter

Abstract

In patients with suspected myocardial ischemia and non-diagnostic ECG contrast agents are recommended in all technically difficult ICU and ED patients to more quickly and accurately diagnose potentially life-threatening conditions and to reduce the need for downstream diagnostic testing. This chapter is aligned to the Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Imaging (EACVI) 2017 and the 2018 American Society of Echocardiography Focused Update Regarding Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography and gives advice how to use contrast agents in patients with acute coronary syndroms.

Supplementary material

Video 7.1

Dilated hypokinetic LV on 2D echocardiography suggesting dilated cardiomyopathy, end-diastolic LV volume exceeding 300 mL, secondary mitral regurgitation (WMV 882 kb)

Video 7.2a

Myocardial contrast echocardiography at rest, lack of myocardial opacification apical lateral and apical anterior indicating a perfusion defect (WMV 303 kb)

Video 7.2b

Myocardial contrast echocardiography at rest, lack of myocardial opacification apical lateral and apical anterior indicating a perfusion defect (WMV 325 kb)

Video 7.3a

Stunned myocardium after apical STEMI (left), the apical myocardium is akinetic but opacified; ‘no reflow’ despite successful recanalization of the epicardial LAD (right), the apical myocardium is akinetic and has a perfusion defect at rest (AVI 16244 kb)

Video 7.3b

Stunned myocardium after apical STEMI (left), the apical myocardium is akinetic but opacified; ‘no reflow’ despite successful recanalization of the epicardial LAD (right), the apical myocardium is akinetic and has a perfusion defect at rest (AVI 9101 kb)

Video 7.4

Longitudinal strain, 4-, 2- und 3-chamber view 7 days after anterior. Dyskinetic apical-anterior segment, and akinetic mid anterior, apical septal, mid anteroseptal, apical lateral und mid anterolateral segments (16-segment-modell) (WMV 723 kb)

Video 7.5

The myocardial segments with microvascular obstruction (no reflow) are highlighted by the red line. These segments appear dark compared to opacified basal inferoseptal, basal inferior und mid inferior segments (WMV 1116 kb)

Video 7.6

Pericardial effusion around the LV apex, contrast agent in the effusion (yellow arrows) (AVI 19045 kb)

Video 7.7top

TEE performed in a patient in whom coronary perforation was suspected, transgastric short axis view. The recording before injection (top) of the contrast agent shows a pleural and a pericardial effusion with a hematoma (*). The echogenicity of the hematoma resembles to that of liver tissue. After injection of the contrast agent (bottom) the LV cavity is opacified, but no contrast is displayed in the pericardial effusion. This finding excludes ongoing bleeding (AVI 20674 kb)

Video 7.7bottom

TEE performed in a patient in whom coronary perforation was suspected, transgastric short axis view. The recording before injection (top) of the contrast agent shows a pleural and a pericardial effusion with a hematoma (*). The echogenicity of the hematoma resembles to that of liver tissue. After injection of the contrast agent (bottom) the LV cavity is opacified, but no contrast is displayed in the pericardial effusion. This finding excludes ongoing bleeding (AVI 83684 kb)

Video 7.8top

TEE, contrast bubbles in the pericardial effusion (transgastric modified long axis, left) in a patient with posterior aortic root rupture during transcutaneous aortic valve implantation. The posterior aortic root was not well visualized. After injection and 0,2 mL Luminity® multiple bright echo spots are found anterior to the RV indicating ongoing bleeding from the rupture. Because of the contrast echocardiography findings the patient was referred to a thoracic CT which showed hematoma caused by posterior aortic root rupture (AVI 28717 kb)

Video 7.8bottom

TEE, contrast bubbles in the left sided pleural effusion (mid esophageal position of the probe directed towards the descending aorta, right) in a patient with posterior aortic root rupture during transcutaneous aortic valve implantation. The posterior aortic root was not well visualized. After injection and 0.2 mL Luminity® multiple bright echo spots are found in the left sided pleural effusion indicating ongoing bleeding from the rupture. Because of the contrast echocardiography findings the patient was referred to a thoracic CT which showed hematoma caused by posterior aortic root rupture (AVI 12832 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Harald Becher
    • 1
  • Andreas Helfen
    • 2
  1. 1.University of Alberta HospitalEdmontonCanada
  2. 2.St. Marien Hospital, Katholisches Klinikum Lünen GmbHLünenGermany

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