Accepted
at 4:36 p.m. Apr, 06, 2025
by
robhornberger
Author:
menganzhu
Type of change:
Spelling/Grammar
Rationale for change
aneurysm
Before
After
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Extra
inducible dyskinesia --> cath
True ventricular aneurysm Occurs 2 weeks to several months after MI. Outward bulge with contraction (“dyskinesia”), associated with fibrosis.
🧠 Memory
🎨 Picture a dead heart muscle segment after MI — it just SITS there doing nothing (AKINESIA = Absent motion). Now picture a true aneurysm: the fibrous scar is so weak it BALLOONS OUTWARD when the rest of the heart squeezes inward (DYSKINESIA = Disordered Direction). "A" for Absent. "DYS" for wrong Direction.
🔥 Pathophysiology
The full RWMA spectrum reflects increasing myocardial damage severity: hypokinesia (reduced thickening — stunned/hibernating myocardium) → akinesia (absent thickening — transmural infarct) → dyskinesia (paradoxical outward systolic bulge — full-thickness scar). True ventricular aneurysm forms 2 weeks to several months post-MI as fibrotic tissue replaces infarcted myocardium and cannot resist systolic LV pressure.
🚨 EM Pearls
True ventricular aneurysm Occurs 2 weeks to several months after MI. Outward bulge with contraction (“dyskinesia”), associated with fibrosis.
Akinesia
Dyskinesia
🧠 Memory
🎨 Picture a dead heart muscle segment after MI — it just SITS there doing nothing (AKINESIA = Absent motion). Now picture a true aneurysm: the fibrous scar is so weak it BALLOONS OUTWARD when the rest of the heart squeezes inward (DYSKINESIA = Disordered Direction). "A" for Absent. "DYS" for wrong Direction.
🔥 Pathophysiology
The full RWMA spectrum reflects increasing myocardial damage severity: hypokinesia (reduced thickening — stunned/hibernating myocardium) → akinesia (absent thickening — transmural infarct) → dyskinesia (paradoxical outward systolic bulge — full-thickness scar). True ventricular aneurysm forms 2 weeks to several months post-MI as fibrotic tissue replaces infarcted myocardium and cannot resist systolic LV pressure.
🚨 EM Pearls
- Wall motion scoring system: 1 = normal · 2 = hypokinesis · 3 = akinesis · 4 = dyskinesis · 5 = aneurysm. Any score >1 = RWMA.
- Pitfall: Dyskinesia is not exclusive to chronic aneurysm — inducible dyskinesia on stress echo or in an acute MI territory should prompt urgent coronary angiography.
- RWMA on POCUS localizes the coronary territory: anterior = LAD; inferior = RCA; lateral = LCx. New RWMA + chest pain = ACS until proven otherwise.
Personal Notes
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Citations
Source: INTERESTING ECHO. Akinesia, hypokinesia, dyskinesia, aneurysm [Video]. YouTube; 2022 Oct 23 [cited 2026 Jul 7]. Available from: https://www.youtube.com/watch?v=Duxj34MMRDQ.
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