Consider dilated and poor functioning left ventricle

Particularly with the following conditions:

– Ischaemic heart disease
– Dilated cardiomyopathy
– Sepsis
– Volume overload
– Aortic valve stenosis (end stage)
– Aortic and mitral valve insufficiency (LV function is often normal or hyperdynamic

Video clips of the parasternal short axis view

Notice:

– Reduced myocardial thickening
– Reduced endocardial movement
– The myocardial wall may appear thin

Video clips of the parasternal long axis view

Notice:

– LV is enlarged
– LA is enlarged
– Anterior mitral leaflet opening is compromised; MSS increased
– The myocardial wall may appear thin
– Reduced contractility

Evaluation of cardiac function is one of the key elements of FATE

This lesson has given you an overview of the simplest way of assessment of right and left ventricular function based on greyscale imaging (2D and M-mode)

Qualitative methods (eyeballing) and semi-quantitative methods (ejection fraction (EF), fractional shortening (FS), mitral septal separation (MSS), MAPSE = mitral annular plane systolic excursion (LV), TAPSE = tricuspid annular plane systolic excursion (RV)) have been employed as measures of left and right ventricular function in the focused approach to the assessment of cardiac function

It should be emphasised that all four cardiac chambers contribute to the overall cardiac function and should be evaluated together

Cardiac function and ventricular function in particular should always be considered together with significant pathological conditions (hypovolaemia, pericardial effusion, pulmonary embolus, pendulating processes etc)

This is the end of the cardiac function lesson. When you feel confident, test yourself in the lesson quiz, before moving on to the next lesson: the FATE findings concerning important pathologies

The FATE card provides the normal cardiac and pleural target images, as well as images of the most important cardiac pathologies and their presentation in the different FATE views

You will be guided through all the relevant cardiac pathologies

Page 3 on the FATE card – which visualises important pathology – is seen below

In this lesson you will learn the ultrasound features of:

Sonographic recognition of pathological conditions in real time at the bedside facilitates good patient care

Ultrasound can visualise cardiac and pleural pathology directly and in real time at the bedside

Recognition of relevant pathology is a key competency in the FATE examination

In this module you will see and learn how to recognise the relevant pathology using the standard FATE examination

You can download the FATE card from: usabcd.org/FATE-card

In the past it has been common to measure RV dimensions on the 2D image

The right ventricle dimension is measured on the apical 4 CH or modified 4 CH view

On the screen:
1. Display the correct 4 CH view
2. Freeze the image in diastole
3. Measure mid-cavity at the level of the papillary muscles of the left ventricle

When appropriate:
1. Measure the basal RV diameter
2. Measure the base-to-apex length

On the M-mode recording:

1) Mark the AV-plane in diastole at the R-wave or the longest distance from the top of the M-mode image

2) Mark the AV-plane in systole – shortest distance from the systolic top of the M-mode recording to the diastolic AV-plane

3) Measure the distance = dimensional change from diastole to systole

4) Use the FATE card for normal values and conversion to EF

Normal TAPSE value > 16-20 mm (even higher values can sometimes be seen in young and healthy subjects)

The left atrium diameter has historically been measured on an M-mode scan guided by a 2D parasternal long axis view

A more accurate measure of the left atrium size can be achieved by planimetry

On the screen:

1. Display the apical 4 chamber view

2. Select a diastolic image with the trackball

3. Activate measurement and analysis (machine dependent)

4. Trace the atrium as shown on the image to the right

5. Pulmonary veins, aneurysms, and left atrial appendage are all circumnavigated