Coronary anatomy: Wall motion abn
Basic, Organ-Based and Clinical Sciences
Wall motion is assessed in the LV. Ischemia is the most common cause of wall motion abnormalities (WMA). In the setting of ischemia, contractility is downregulated or can be completely ceased. The degree of WMA correlates with severity and extent of ischemia, with moderate ischemia resulting in hypokinesis and more severe ischemia causing akinesis (also known as stunned myocardium). Stunned myocardia can normalized if the ischemic insult is alleviated before infarction occurs. The distribution of WMA should match the territory of a coronary artery. While MI is the most common cause of WMA, other causes can include LBBB, dilated CM, constrictive pericarditis, takotsubo, and RV stain to name a few.
Scoring is based on an assigned contractility of the 17 segments assessed in different views on echo. 1- normal, 2- hypokinesia, 3- akinesia, 4-dyskinesia. Then, the total is divided by 17. If all segments are normal the ratio would be 1. A higher ratio would indicate a more severe WMA.