Background:Ischemic heart disease is the number one cause of mortality worldwide resulting in 7 million of the 53 million deaths in reported in 2010. Acute coronary syndrome is divided into ST-elevation myocardial infarction (STEMI), Non ST-elevation myocardial infarction (NSTEMI) and unstable angina. NSTEMI and unstable angina share similar pathophysiology and have similar clinical presentation with the only difference is positive cardiac biomarkers (cardiac Troponins and CK-MB) in the case of NSTEMI. Two dimensional (2D) speckle tracking echocardiography is a relatively new imaging technique. Like tissue Doppler imaging (TDI), it allows calculation of myocardial velocities and distortion parameters like strain and strain rate (SR) giving important information for assessment of systolic and diastolic function, particularly longitudinal strain, which both sensitive and specific in post myocardial. The main advantage of speckle tracking analysis is its ability to assess several planes (circumferential, radial and longitudinal) giving accurate data about LV dimensions and deformation with good correlation to tagged cMR and sonomicrometry as reference methods.The accuracy and sensitivity of detecting MI visually by detecting segmental wall motion abnormalities are moderate and operator dependent but improve greatly by using speckle analysis.