Should we measure LV EF in the early hours of STEMI ?

LV ejection fraction (EF) is the most commonly used  LV systolic functional index.Since , it is an  easily acquired parameter,  it’s popularity has zoomed among both learned and novice cardiology professionals .(Not withstanding the serious shortcomings!) In one of the evening rounds  in my CCU , a young cardiology fellow told me about a  patient  with acute  anterior MI with ST elevation V1 to V5. The patient  was lying supine with trunk up . HR was 110 . BP was  100 /70 There were few basal crackles .The patient was undergoing  lysis with streptokinase. It was  suggested  to me by the  fellow  that  the patient is  going in for “Impending  cardiogenic shock since his EF is just 30%” That prompted me to ask this question How good is the EF  a measure  of size of MI during STEMI ? EF during  STEMI  is highly variable parameter.The following are important con-founders in LV EF measurement during STEMI.   Acute ischemia induced LV dysfunction .(Ischemic stunning from  the watershed zone  significantly over estimate LV dysfunction) Mitral regurgitation  if present will underestimate it Effect of tachycardia and bradycardia can be significant The posture of the patient and  measurement errors (A good Simpson score is rarely  possible in a sick patient ) Associated  hemo -dynamic drugs like NTG/Dopamine etc which alter  pre and after load   and changes the frank starling forces. * Please recall  , LV EF is never included as a...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Cardiology -unresolved questions Echocardiography - LV dysfunction Echocardiography-Limitations of LV EF % Infrequently asked questions in cardiology (iFAQs) asessing LV function following stemi echocardiography in stemi LV ejection fraction Source Type: blogs