Non ischemic wall motion abnormalities
- Septal Flattening
RV pressure or volume overload :Owing to the interdependence between ventricular chambers, the changed loading state characteristic of RV overload is responsible for the development of septal flattening, described also as a D-shaped ventricle - Abnormal Septal Motion in Constrictive Pericarditis (Septal Bounce and Ventricular Interdependence)
Septal bounce represents a typical pattern of septal motion that occurs in constrictive pericarditis.Owing to the presence of a thickened, fibrotic, and/or calcific pericardium, the heart is constricted and cardiac filling is impaired. - Septal Flash
In LBBB, there is preferential electrical conduction through the right bundle, leading to electrical activation of the right half of the septum and the right ventricle first. Delayed activation of the left ventricle leads to early right to left movement of the septum (perceived as dyskinesis), with delayed activation of the posterolateral wall region. - Abnormal Septal Motion in Preexcitation
As in bundle branch block, preexcitation due to accessory pathway conduction is responsible for an abnormal myocardial electrical activation that, in turn, could lead to mechanical dyssynchrony and regional wall motion abnormality. - Post–Cardiac Surgery Septal Motion
Usually ASM appears immediately after surgery and resolves with time, although it can persist indefinitely in some patients. As displayed by 2D and M-mode echocardiography, it is characterized by anterior motion of the IVS during systole with preserved thickening. - Mitral stenosis
In mitral stenosis, an early diastolic leftward septal motion can be observed. This is due to an abnormal early diastolic transseptal pressure gradient secondary to delayed LV filling observed in mitral stenosis. With continued filling of the LV, the normal transseptal gradient is reestablished and the septum moves progressively rightward - Cardiac transplant
- Paced Hearts
The right ventricular pacing can produce regional wall motion abnormalities at the site of pacing wire insertion. Chronic right ventricular pacing has also been linked to asymmetrical septal hypertrophy, dilatation of the left ventricle, and a deterioration in LV systolic function over a period of time. In fact, the right ventricular outflow pacing produces lesser regional wall motion change compared to the right ventricular apical pacing - Nonischemic Cardiomyopathy and Takotsubo cardiomyopathy
Most patients with nonischemic cardiomyopathy have global LV dysfunction. However, segmental wall motion abnormalities, i.e., wall motion changes in at least two echocardiographic segments, have been found to present, secondary to myocardial scar formation. - Hypertension
Regional wall motion in patients with hypertension has been reported with co-existent LV hypertrophy. Often, wall motion abnormalities seen in hypertension are associated with underlying myocardial ischemia. In one particular study, 7% of patients with hypertension and LV hypertrophy demonstrated regional wall motion changes affecting the ventricular septum and the posterior wall. - Myopericarditis
Regional wall motion abnormalities are not uncommon in myopericarditis. Global hypokinesis may be seen, but the commonly affected areas as the inferoposterolateral LV wall.Strain imaging has found lower longitudinal and circumferential strain.
