Combined Assessment of Myocardial Perfusion and Diastolic Function Enhances Risk Stratification in Patients with Anterior Wall Myocardial Infarction

Impaired left ventricular systolic function secondary to sepsis can occur in up to 20% of patients with septic shock. The electrocardiogram (ECG) and echocardiographic changes it produces can be very similar to those occurring during acute coronary syndromes (ACS). Myocardial contrast echocardiography (MCE) allows assessment of myocardial perfusion. This technique can be performed at the bedside of the critically unwell patient. We describe a patient presenting with septic shock secondary to pneumonia. While sedated and ventilated in the intensive care unit, the patient developed marked ECG changes, a troponin rise and widespread left ventricular wall motion abnormality. The clinical picture suggested ACS or stress cardiomyopathy was unlikely and was more in keeping with a diagnosis of sepsis-induced left ventricular systolic dysfunction. To support this, resting and flash impulse MCE was performed which revealed normal perfusion in areas of both normal and abnormal wall motion. This suggested that the cardiac presentation was more likely to be due to left ventricular impairment secondary to sepsis and ACS therapy was discontinued. Pre-discharge ECG and transthoracic echocardiogram were normal. Percutaneous coronary angiography 6 weeks later was also normal. This is the first described case of MCE being used to aid in the decision-making process in distinguishing between ACS, stress cardiomyopathy, and left ventricular systolic impairment secondary to sepsis.

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Myocardial perfusion echocardiography: a novel use in the diagnosis of sepsis-induced left ventricular systolic impairment on the intensive care unit

Sado

Greaves

2010

European Journal of Echocardiography

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Evolving focus on diastolic dysfunction in patients with coronary artery disease

Ohara

Little

2010

Current Opinion in Cardiology

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Combined Assessment of Myocardial Perfusion and Diastolic Function Enhances Risk Stratification in Patients with Anterior Wall Myocardial Infarction

Abstract: Combined assessment of diastolic function and myocardial perfusion enhances risk stratification post myocardial infarction.

Cited by 2 publications

References 17 publications

Myocardial perfusion echocardiography: a novel use in the diagnosis of sepsis-induced left ventricular systolic impairment on the intensive care unit

Myocardial perfusion echocardiography: a novel use in the diagnosis of sepsis-induced left ventricular systolic impairment on the intensive care unit

Evolving focus on diastolic dysfunction in patients with coronary artery disease

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