Regional Wall Motion Abnormalities

Question 1

Where does the LAD run?

Answer 1

Along the anterior interventricular groove

Question 2

What does the LAD supply in terms of blood?

Answer 2

Anterior wall and septum

Question 3

What does the Circumflex (Cx) give ris to?

Answer 3

The PDA in 20% of cases

Question 4

Where does the RCA run?

Answer 4

Heads right and towards back of the heart lateral

Question 5

What does the RCA supply?

Answer 5

SA and AV nodes

Question 6

What does the RCA give rise to?

Answer 6

PDA in 80% of cases (right dominant)

Question 7

Label the colours

Answer 7

Question 8

Label the image

Answer 8

Question 9

RV myocardial Infarction (RVMI) is usually associated with what?2

Answer 9

1. Inferior MI
2. Papillary muscle dysfunction and ischemic MR

Question 10

How common is Isolated RVMI?

Answer 10

Rare

Question 11

During RVMI, the inferior wall is perfused by what?

Answer 11

RCA

Question 12

When is McConnel sign usually seen?4 (what does it mimic)

Answer 12

1. Post PE (pulmonary embolism)
2. Akinetic RV free wall
3. Apex maintains preserved function
4. Mimics RVMI

Question 13

What do we assess for during wall motion analysis? 4

Answer 13

1. Wall motion (Hypokinesis, Akinesis, Dyskinesis of affected wall segments)
2. Thinning of wall segments
3. Increased echogenicity of affected wall segments
4. Hyperkinesis of opposing walls

Question 14

What can we use to help with kinetic analysis? 4

Answer 14

1. Use wall motion index or strain imaging
2. Contrast may be helpful
3. Perfusion may be adequate at rest
4. Stress echo may be indicated

Question 15

During WMA, if wall motion alone is not enough to be considered normal, what else must we see?

Answer 15

Walls must thicken during systole

Question 16

What are 3 Caveats of WMA?

Answer 16

1. The absence of a RWMA does not exclude the possibility of ischemia
2. Abnormal septal motion may be seen with LBBB, WPW (wolf- Parkinson white syndrome) or paced rhythms
3. Abnormal wall motion may be seen with subarachnoid hemorrhage, cardiac sarcoidosis and tokotsubo cardiomyopathy

Question 17

What is hyperkinesis?

Answer 17

Enhanced wall motion

Question 18

What is normal wall thickening?

Answer 18

> 40% wall thickening

Question 19

What is hypokinesis?

Answer 19

Reduced wall thickening and motion (<40%, but >5%)

Question 20

What is akinesis?

Answer 20

No wall thickening or very little (<5%)

Question 21

What is dyskinesis?

Answer 21

No wall thickening + moving the opposite way (outward)

Question 22

What are the 4 WMA scores?

Answer 22

1. Normal wall motion
2. Hypokinetic motion
3. Akinetic
4. Aneurysmal (dyskinetic)

Question 23

The higher the wall motion score, the lower the what?

Answer 23

The systolic LV function