Regional wall motion abnormality (RWMA) on an echocardiogram

Regional wall motion abnormality (RWMA) on an echocardiogram


Regional wall motion abnormality on an echocardiogram means that a region of the heart muscle is not contracting as it normally should. Short form often used is RWMA. RWMA is a very common medical abbreviation seen on echocardiogram reports. No regional wall motion abnormality means there is no abnormality in the contraction of the various parts of the heart muscle.

The various abnormalities in contraction of regions of the heart muscle could be:

  1. Decrease in the amplitude of contraction known as hypokinesia
  2. Absence of contraction known as akinesia
  3. Paradoxical bulging out when the rest of the heart muscle contracts, known as dyskinesia.

Regional wall motion abnormality usually suggests abnormality in the blood flow to the corresponding region of the heart muscle (myocardium). Regional wall motion abnormality on an echocardiogram is a common finding after a heart attack.

Other types of heart muscle disease can also sometimes cause RWMA. A condition known as broken heart syndrome (Takotsubo cardiomyopathy) occurring as a result of severe stress can cause regional abnormalities in contraction. In this condition, basal regions of the heart contract well while those regions towards the tip do not contract well. Inflammation of the heart (myocarditis) can also sometimes cause RWMA, though more often it is a global decrease in contraction in myocarditis.

American Society of Echocardiography has divided the left ventricle (lower muscular chamber of the heart ) into seventeen segments for assessment of RWMA [1]. It may noted that though heart muscle is present in all four chambers of the heart, while assessing RWMA, usually only the lower left muscular chamber of the heart known as left ventricle is taken into account.

Wall motion abnormalities can also occur in the right ventricle (lower right muscular chamber of the heart). Since the interventricular septum which separates the right and left ventricle, is taken as part of the left ventricle, only free wall of the right ventricle is considered while mentioning wall motion abnormalities of the right ventricle. Wall motion abnormality of the right ventricle can be seen in heart attacks involving the right ventricle and in a condition known as pulmonary embolism, in which clots arising in other parts of the body move into the blood vessels of the lung.

Reference

  1. Chengode S. Left ventricular global systolic function assessment by echocardiography. Ann Card Anaesth. 2016 Oct;19(Supplement):S26-S34. (Free Full Text at Pubmed Central).