Anterior Wall Ischemia

 

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The views below are videos from standard treadmill stress echocardiogram. The individual in question experienced chest pain and shortness of breath on the treadmill before reaching 85% predicted HR and the test was stopped early. The stress images below show a marked anterior wall and anteroseptal wall motion abnormality. Cardiac catheterization showed a tight proximal LAD stenosis. For each view below, videos are shown for the different time points where images where acquired: at rest (top right), during peak stress (top left), and post exercise at rest (bottom left). The bottom right quadrant is left blank.

Parasternal Long Axis

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At rest there is normal LV function, however at stress (upper right) we see abnormal motion of the anteroseptum. It is not thickening normally and the LV cavity does not appear to get much smaller is systole, which it should. With stress the EF should be higher and the LV cavity smaller. At rest we see there is again thickening of the anteroseptum. The inferolateral wall appears to contract in all views

Parasternal Short Axis

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Here at the level of the mid ventricle we see at rest there is normal wall motion. All segments come toward the center of the ventricle and all segments appear to be thickening. However at stress (top right panel) the anteroseptum and anterior wall are not thickening well or moving toward the center compared to the other segments. There is recovery of function at rest (bottom panel).

Apical 4 Chamber

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In the apical 4 chamber view we are mostly seeing the lateral and septal walls of the LV. Here we see good augmentation of LV function at stress with thickening of both of these segments. The EF appears increased during stress as expected.

Apical 2 Chamber

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Finally the 2 chamber view shows the inferior wall thickens normally with stress, but the anterior wall does not.