Formal echocardiography

Diagnostic Pearls

• Normal directional flow in CW and PW in apical, parasternal short:
  • Below the line for pulmonic and aortic valves (systole)
  • Above the line in tricuspid and mitral valves (diastole)
• Parasternal long
  • Assess for mitral valve prolapse, systolic anterior motion
  • Differentiate pleural effusion from pericardial effusion
    • Pericardial effusion is anterior to descending aorta
    • Pleural effusion posterior to descending aorta

Pericardial effusion vs. pleural effusion

• Apical
  • Best obtained in left lateral decubitus with L arm above head to open up ribs
  • LVEF by Simpson, LV volume change
  • LVEF by Teichholz method, using M-mode (estimation of LV volume by diameter measured just beyond mitral tips in diastole)
  • EF visual assessment:
    • >65% = hyperdynamic
    • 55-65% = normal
    • 45-54% = mildly depressed
    • 30-44% = moderately depressed
    • <30% = severely depressed

References

• Critical USG. Echocardiographic evaluation of left ventricular systolic function. 2012. http://www.criticalusg.pl/en/echo/tte/tutorials/echocardiographic-evaluation-of-lv-systolic-function.