Taking the time to get it bright: Use of ultrasound enhancing agent redirects clinical course of an unstable patient

The use of ultrasound enhancing agents (UEA) during echocardiography helps to optimize visualization in technically difficult studies, with improved left ventricular opacification and endocardial border definition. The use of these agents may often unveil critical data that drastically alter clinical decision making. Despite the potential clinical benefits of UEA and known safety data, clinicians are still sometimes reluctant to take the time to use UEAs in unstable patients. Herein, we demonstrate a challenging case of a patient with late presentation myocardial infarction, complicated with cardiogenic shock and pseudoaneurysm formation that was not observed in non-contrast images, emblematically demonstrating the value of UEA in selected patients. <Learning objective: Ultrasound enhancing agents (UEAs) improve left ventricular opacification and endocardial border definition during echocardiography and can be used in a wide variety of different clinical settings. Despite the known clinical benefits of these agents and established safety data, clinicians are still sometimes reluctant to take the time to use UEAs in unstable patients. We demonstrate a case where the use of UEAs completely transformed clinical decision making.>.