What do inferolateral and inferior akinesis and lateral hypokinesis on an echocardiogram indicate, explained simply for a new provider?

Understanding Inferolateral, Inferior Akinesis and Lateral Hypokinesis on Echocardiogram

This echo finding indicates that specific regions of the left ventricle are not contracting normally: the inferolateral and inferior walls are completely non-moving (akinetic), while the lateral wall is contracting weakly (hypokinetic). 1

What These Terms Mean

Akinesis means the heart muscle in that segment is not moving at all during contraction—it's essentially paralyzed. 2, 3

Hypokinesis means the heart muscle is moving, but with reduced strength and amplitude compared to normal segments. 2, 4

Anatomical Location and Clinical Significance

The inferior wall sits at the bottom of the left ventricle, the lateral wall runs along the left side, and the inferolateral wall is where these two regions meet. 1

This specific pattern of wall motion abnormalities typically indicates coronary artery disease affecting the distribution of either the right coronary artery (RCA) or left circumflex artery (LCx). 1

• The inferior wall is predominantly supplied by the RCA in most patients 1
• The lateral and inferolateral walls are supplied by the LCx 1
• When both territories are involved (as in this case), it suggests either multivessel disease or LCx dominance 1

What This Means for the Patient

These wall motion abnormalities indicate prior myocardial infarction (heart attack) or severe ongoing ischemia in these territories. 1

• Akinetic segments are typically infarcted (dead) myocardium, though viability assessment with advanced imaging may be needed 3
• Hypokinetic segments may represent stunned myocardium, hibernating myocardium, or partial-thickness infarction 3, 4
• The extent of involvement (three separate regions) suggests significant myocardial damage that will impact overall left ventricular function 5

Critical Next Steps

Immediate correlation with the patient's clinical presentation is essential:

• If this is a new finding with acute chest pain, consider acute coronary syndrome requiring urgent catheterization 1
• If the patient has known prior MI, this represents established scar tissue 1, 2
• Check the reported ejection fraction—extensive akinesis in these territories typically reduces EF significantly 2, 5

Look for associated ECG findings:

• Inferior wall involvement typically shows changes in leads II, III, and aVF 1
• Lateral wall involvement shows changes in leads I, aVL, V5, and V6 1
• Old Q waves in these territories confirm prior infarction 1

Important Caveats

Do not confuse this with stress (Takotsubo) cardiomyopathy, which typically shows apical ballooning with basal hyperkinesis—a completely different pattern. 1, 6

The distribution matters: Wall motion abnormalities that follow coronary artery territories (as in this case) indicate ischemic heart disease, whereas non-coronary distributions suggest cardiomyopathy. 1, 6

Viability assessment may be warranted: Even akinetic segments can sometimes recover function after revascularization if viable myocardium remains. 3