Document Detail


Value of regional wall motion abnormality in the emergency room diagnosis of acute myocardial infarction. A prospective study using two-dimensional echocardiography.
MedLine Citation:
PMID:  1884510     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Because regional wall motion abnormality (RWMA) is usually noted during ischemia, we hypothesized that the presence of this finding with two-dimensional echocardiography would be superior to conventional methods of diagnosing acute myocardial infarction (AMI) in the emergency room. We also hypothesized that because the absence of RWMA would probably not be associated with AMI, the use of two-dimensional echocardiography would significantly limit unnecessary hospital admissions. To test these hypotheses, we undertook a prospective study that used two-dimensional echocardiography in 180 patients presenting to the emergency room with symptoms suggestive of AMI. The emergency room physicians were not informed of the two-dimensional echocardiography findings, and their decision to admit or not admit to the hospital was based on conventional clinical and electrocardiographic criteria. Forty patients were not admitted to the hospital and 140 were admitted. Of the 30 patients with enzyme-confirmed AMI, nine had typical ST elevation on the ECG that was consistent with acute injury, three had normal ECGs, and eight had ECGs in the presence of which AMI could not have been diagnosed (left bundle branch block, paced rhythm, or repolarization changes); the rest had nonspecific ECG findings. Of the 29 AMI patients with technically adequate two-dimensional echocardiography studies, two did not demonstrate RWMA and 27 had RWMA, compared with nine with diagnostic ECG changes (p less than 0.001). Of the 13 patients with in-hospital complications only four had an initial ECG showing ST elevation, and all 13 had RWMA (p less than 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)
Authors:
P Sabia; A Afrookteh; D A Touchstone; M W Keller; L Esquivel; S Kaul
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  84     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1991 Sep 
Date Detail:
Created Date:  1991-10-04     Completed Date:  1991-10-04     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  I85-92     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville 22908.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Coronary Care Units / economics
Diagnosis, Differential
Echocardiography*
Electrocardiography
Emergency Service, Hospital
Evaluation Studies as Topic
Female
Hospitalization / economics
Humans
Male
Middle Aged
Myocardial Infarction / diagnosis*
Prognosis
Prospective Studies
Grant Support
ID/Acronym/Agency:
5S07RR-05431/RR/NCRR NIH HHS; K08-HL-01833/HL/NHLBI NIH HHS; R29-HL-38345/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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