Q. Analyze the Regional Wall Motions?

Ans.

Various attempts have been made in the past to try and quantify the ischemic myocardium, however till date the best and most widely used is the 16 segment scoring system, which has also been approved by American society of Echocardiography. The system was devised keeping in mind the common pattern of coronary blood supply. The whole of the left ventricle muscle is divided into 16 segments, which can be visualized in the conventional views. The whole length of the LV is divided into 3 segments. The apical, mid segment and basal segment. The circumference of basal and mid myocardium is divided into 6 segments-Anterior Segment, Anterior wall, lateral wall, posterior wall, inferior wall and septum. The apical portion however lacks anterior septum and posterior wall.

If the translate these segments into other conventional views, we find that parasternal long axiq view shows anterior septum and posterior wall, apical 4 chamber view show$ septum and lateral wall and apical 1 chamber view shows inferior and anterior; wall.

With variable degree of overlap the segments marked above denote coronary artery territory. These can be plotted on a Bull's eye plot, which gives a better appreciation of the segments and the regions involved.