UMEM Educational Pearls

Category: Cardiology

Title: FOCUS for RWMA

Keywords: POCUS, ACS, Regional Wal Motion Abnormality, Ultrasound (PubMed Search)

Posted: 5/1/2023 by Alexis Salerno, MD (Updated: 12/11/2023)
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In this study the researchers looked at patients presenting to the emergency department with high suspicion for ACS and explored if Regional Wall Motion Abnormality (RWMA) evaluation by EPs was associated with occlusion myocardial ischemia (OMI).

FOCUS identified RWMA in 87% of patients with coronary angiography proven OMI. With a sensitivity of 94%, specificity 35%, and overall accuracy of 78%.  

The authors concluded that using FOCUS can have good utility when a patient is high risk for OMI and has an equivocal ekg. However, if RWMA is not present, physicians should still continue with work up such as cardiac catheterization.  

To evaluate RWMA it is easiest to: 

  • Obtain a parasternal short axis at the level of the papillary muscles 
  • Place your finger on the ultrasound machine in the middle of the LV and watch the walls contract towards your finger 
  • The walls should contract equally towards your finger 

For more information check out this ACEPnow article:



Bracey A, Massey L, Pellet AC, Thode HC, Holman TR, Singer AJ, McClure M, Secko MA. FOCUS amay detect wall motion abnormalities in patients with ACS, A retrospective study. Am J Emerg Med. 2023 Apr 2;69:17-22. doi: 10.1016/j.ajem.2023.03.056. Epub ahead of print. PMID: 37037160.