Role of echocardiography in evaluation of the acute chest pain syndrome in the emergency department

Chest pain is a great concern for the physicians and the patients. Chest pain is a very common presentation with a wide range of differential diagnoses, including life-threatening conditions, which need to be considered, diagnosed and treated urgently. Chest pain or discomfort is a common symptom and accounts for up to 5% of all admissions to the emergency department , and up to 25% of emergency hospital admissions.There are many causes of acute chest pain , not all of which are necessarily cardiovascular in origin. Examples of cardiovascular causes of chest pain include acute coronary syndrome (ACS), myocarditis, pericarditis, hypertrophic cardiomyopathy, aortic stenosis and aortic dissection. Knowledge of global LV systolic function, regional wall motion abnormality(RWMA)and diastolic function by by transthoracic echocardiography is important for diagnosis ,management strategy and definition of prognosis in the patients with CAD. Echocardiography is a valuable non-invasive tool that can help in diagnosing and treating patients presenting with CP. Echocardiography is reproducible,relatively cheap ,no need to radiation and the safe in pregnancy.European Society of Cardiology (ESC) and American Heart Association (AHA) guidelines state that echocardiography can help in the diagnosis of acute coronary syndromes and also in ruling out other serious conditions. There are many novel modalities in echocardiography including TDI,strain,srain rate ,3D echo,contrast echocardiography and speckle tracking that are very useful in diagnosis of the chest pain causes.Stress echocardiography is a valuavble tool for diagnosis of coronary artery disease in emergency department. Sensitivty and specificity of stress echocardiography for obstructive CAD is 86 and 81% , respectively.