Document Detail

Usefulness of two-dimensional echocardiography for immediate detection of myocardial ischemia in the emergency room.
MedLine Citation:
PMID:  2316447     Owner:  NLM     Status:  MEDLINE    
Inappropriate discharge from the emergency room of patients with acute chest pain may have serious consequences. Regional asynergy is one of the first signs of myocardial ischemia and can be detected with 2-dimensional echocardiography (2-DE). This study determines the value of 2-DE in the emergency room for immediate detection of myocardial ischemia causing acute chest pain at the time the electrocardiogram was nondiagnostic. Forty-three patients (32 men and 11 women) with a normal or nondiagnostic electrocardiogram during acute chest pain were studied with 2-DE. Only patients without a previous myocardial infarction and without known coronary artery disease (CAD) were studied. The entire left ventricular wall was examined for presence of regional asynergy. Coronary angiography was performed within 3 weeks. Cardiac enzyme levels were measured serially to establish or rule out an acute myocardial infarction. Sensitivity of 2-DE for detection of myocardial ischemia was 88% (22 of 25), specificity 78% (14 of 18), negative predictive accuracy 82% (14 of 17) and positive predictive accuracy 85% (22 of 26). Sensitivity of 2-DE for detection of acute myocardial infarction was 92% (12 of 13), specificity 53% (16 of 30) and negative predictive accuracy 94% (16 of 17). Thus, 2-DE during pain and a nondiagnostic electrocardiogram can readily identify patients with CAD in the emergency room, and it can accurately rule out an acute myocardial infarction.
C H Peels; C A Visser; A J Kupper; F C Visser; J P Roos
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  65     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1990 Mar 
Date Detail:
Created Date:  1990-04-20     Completed Date:  1990-04-20     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  687-91     Citation Subset:  AIM; IM    
Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands.
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MeSH Terms
Chest Pain / diagnosis
Clinical Enzyme Tests
Coronary Disease / diagnosis*
Creatine Kinase / blood
Diagnosis, Differential
Emergency Service, Hospital
Middle Aged
Myocardial Contraction
Myocardial Infarction / diagnosis
Patient Discharge
Reg. No./Substance:
0/Isoenzymes; EC Kinase

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