Coronary artery disease

Echocardiography is an important tool for the assessment of patients with coronary artery disease (CAD). There are some limitations to its use related to the difficulty of obtaining optimal images. To understand the echocardiographic alterations due to coronary artery disease, it is necessary to have a good knowledge of the cardiac anatomy, especially the wall segments (Figure 5.1). Using echocardiography one can assess regional segments of the affected left ventricular wall in coronary artery disease. These segments fail to thicken during systole — in fact they thin — producing systolic bulging of the ischemic segment. Infarcted myocardium frequently shows an increased echo intensity. Two-dimensional echocardiography, sometimes in association with Doppler echocardiography, has been shown to be effective in diagnosing the mechanical complication of myocardial infarction, including ventricular septal rupture, ruptured papillary muscle, papillary muscle dysfunction, cardiac rupture, ventricular aneurysm, pseudoaneurysm and right ventricular infarction.