Diagnosis of acute coronary occlusion in patients with non-STEMI by point-of-care echocardiography with speckle tracking

Approximately 25% of patients with acute coronary occlusion present without diagnostic evidence of ST elevation on electrocardiogram. Traditionally, individuals that fall into this category have been detected by subsequent elevation of cardiac markers and are diagnosed with non-ST-elevation myocardial infarction. Early detection and intervention of these individuals lead to lower 6-month mortality; however, there has not been a good way to detect these individuals reliably. We report a case of a man presenting to the emergency department (ED) with a non-ST-elevation myocardial infarction who was found to have acute coronary occlusion detected by speckle tracking echocardiography performed by an emergency physician. This diagnosis led to early percutaneous intervention. This case highlights a novel use of ultrasound in the ED for detection of acute coronary occlusion when an electrocardiogram is nondiagnostic.