Usefulness of echocardiography and tissue Doppler imaging (tDI) in the management of the acute patient: a clinical case report

ase Presentation Male, 64 years old,overweight,hypertensive,current smoker. Arrived to our emergency department(ED)for epigastric pain, swe-ating, nausea, bradicardia (45 bpm) and hypotension. At physical exami-nation, pain at palpation in epigastric region. At admission ECG,sinus bradicardia, negative T-waves in inferior leads without ST-segment altera-tions. Blood chemistry showed troponin I 2.18 ng/ml, d-Dimers 1290 ng/ml. Echocardiography showed hypokinesis of left ventricle inferior wall associated to diffuse hypokinesis and systodiastolic dysfunction of right ventricle RV), as diagnosed with TDI (TAPSE not evaluated for suboptimal window). Right chambers didn’t result dilated,with normal PAPs.Inferior vena cava was dilated (25 mm) and non-collapsing.Our first diagnosis was RV NSTEMI-ACS, and the patients was treated and then admitted in our Internal Medicine Department (critical care area). At arrival, a new ECG showed 1 mm ST-elevation in DII,DIII and aVF leads,associated with epi-gastric pain. Patient was then taken to our Hub hospital for urgent corona-rographic examination, which showed an occlusion of 100% in proximal right coronary artery with a large endoluminal thrombotic occlusion. After PTCA and stenting,the patient was admitted again in our department in good clinical conditions.conclusion Echocardiography and ultrasound examination,integrated with TDI examination can be useful to the Internist working in ED and in critical care area for a correct and fast diagnosis. In this case,it is important to enlighten how echocardiography allowed a correct bedside differential diagnosis.