Handheld and miniature echocardiography in acute coronary syndrome

In the United States millions of patients present to the emergency department (ED) annually with signs and symptoms suggestive of acute coronary syndrome (ACS). The electrocardiogram (ECG) is often the first diagnostic tool used by physicians in the triage of patients with chest pain and is an invaluable tool that can guide clinical management decisions including potential reperfusion therapy. Albeit quite useful, the ECG has certain limitations, such as the presence of a paced rhythm, an underlying left bundle branch block, or nonspecific ST-segment changes, which may result in the ECG becoming an indeterminate factor. In this instance, physicians are faced with a daunting challenge and often have to rely on other diagnostic modalities such as a standardized transthoracic two-dimensional echocardiogram (SE) for assessing possible wall motion abnormalities (WMA).