Role of echocardiography in the emergency department for identifying patients with myocardial infarction and ischemia

Echocardiography is a valuable, noninvasive diagnostic tool that can provid e information on systolic function and valvular abnormalities and can provi de alternative explanations for causes of chest pain. Experimental as well as clinical studies have shown that wall motion abnormalities have a high s ensitivity for predicting myocardial infarction. More recent studies, perfo rmed in, the emergency department on patients evaluated for myocardial isch emia, have reported similar results. An important aspect is that necrosis i s not necessary to cause walt motion abnormalities; therefore, echocardiogr aphy can also be used to identify patients with ischemia without infarction . Importantly, sensitivity is significantly higher than that for electrocar diography and is comparable to that for myocardial perfusion imaging. Newer developments, such as digital transmission over telephone lines, may lead to more widespread routine use in the emergency department. Acute emergency department echocardiography appears to be a promising tool when used in th e evaluation of patients with chest pain.