By Thomas H. Marwick
W. F. ARMSTRONG whereas tension echocardiography isn't the first strategy to be utilized to sufferers for the analysis of coronary artery affliction, it represents an impor tant medical software, prone to turn into of accelerating pertinence in cutting-edge period of rate containment and mandated cost-effectiveness of analysis. it can be the main speedily increasing quarter of scientific echocardiography this day. rigidity echocardiography as we all know it at the present time represents the ordinary con clusion and merger of observations revamped fifty years in the past. In 1935 Tenn ant and Wiggers verified that the fast results of a coronary oc clusion, was once a right away abnormality of wall movement . As seen from the outside of the guts in an open chest puppy education, cyanosis and visible paradoxical bulging of the left ventricular wall was once famous. At an identical time Masters and associates, utilizing relatively rudimentary workout de vices, defined the reaction of the human cardiovascular method to sustained workout (Figure 1) . those observations diverged for 4 a long time whereas scientific research used to be pursued alongside the 2 parallel lines.
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Additional resources for Stress Echocardiography: Its Role in the Diagnosis and Evaluation of Coronary Artery Disease
Two-dimensional echocardiographic analysis of wall motion abnormalities during handgrip exercise in patients with coronary artery disease. Am J CardioI1981;48:711-7. 10. Mancini GBJ, Peterson KL, Gregoratos G, Higgins CB. Effects of atrial pacing on global and regional left ventricular function in coronary heart disease assessed by digital intravenous ventriculography. Am J CardioI1984;53:456-61. 11. Iliceto S, Sorino M, D'Ambrosio G et al. Detection of coronary artery disease by twodimensional echocardiography and transesophageal atrial pacing.
1 ...... _ ... t.. : ....... 'L .... l ___ 1 ___ ..... ___ ..... ~ __ ~ !. ____ 1-_ .. 1 26 T. 7. Segmentation of the left ventricle, showing assumed perfusion territories of the 3 major coronary vessels in parasternal long axis, short-axis, apical four-chamber and apical twochamber views. Other difficulties arise with this algorithm for the echocardiographic diagnosis of infarction. First, small (especially non Q-wave) infarcts may not cause any wall motion abnormality, or cause hypokinesia, which is not recognised as infarction.
These findings correspond to the limitations of examining global left ventricular functional parameters (see below), as these are relatively insensitive to small areas of ischemia, which do not compromise global cardiac function. Moreover, stress-induced alterations in global cardiac function are not specific for coronary disease. For these theoretical and practical reasons, stress Doppler examinations of systolic function have not found clinical application. Ischemia-induced alterations of left ventricular filling may be examined by Doppler measurements of transmitral flow.