Table 15.

Echocardiographic findings and treatments of mechanical complications which may develop in patients with acute coronary syndromes

Diagnosis	Echocardiographic findings	Initial treatment	Advanced treatment
Right ventricular myocardial infarction	•Supports ECG and clinical findings •Right ventricular dilatation •Movement disorder on right ventricular free wall	•Stop nitrates •Dont give diuretics •Load fluid •Correct bradycardia	•PCI/Thrombolytic •IABP •Inotropic treatment (levosimendan)
Free wall rupture	•Pericardial effusion •Tamponade •Echogenic particules in effusion	•Pericardiosynthesis •Load fluid •IABP	• Emergency surgery
Ventricular septal rupture	•Location, size, Qp/Qs •Right heart catheterisation if findings are uncertain	If stable with medical treatment	•Coronary angiography •Immediate surgery
		If hemodynamic unstability •IABP •Intubation •Right heart catheterisation	•Coronary angiography •Emergency surgery
Acute mitral regurgitation	•Acute mitral regurgitation •Papillary muscle rupture •TEE if findings are uncertain •If TEE is not adequate: Right heart catheterisation (to exclude ventricular septal rupture)	If stable with medical treatment	•Coronary angiography •Immediate surgery
		If hemodynamic unstability •IABP •Intubation •Right heart catheterisation	•Coronary angiography •Emergency surgery
Dynamic LV outflow tract obstruction	•Akinetic apex •Hyperdynamic basal IVS •Systolic anterior motion (SAM)	Drugs to be discontinued •Inotropics •Nitrates •IABP	Drugs to be given: Beta-blocker

ECG - electrocardiography; IABP - intra-aortic balloon pump; IVS - interventricular septum; PCI - percutaneous coronary intervention; Qp/Qs - ratio of pulmonary flow (Qp) to systemic flow (Qs); TEE - transesophageal echocardiography