On the screen:
1) Display the parasternal long axis view (PLAX)
2) Make sure you transect the LV so it appear largest
3) Freeze a full cine loop covering a whole heart cycle
4) Use the trackball to scroll to diastole (just before the aortic valve opens)
5) Activate the measurement button (machine dependent)
6) Measure as perpendicular to the septum and posterior wall as possible
7) Measure only the free of the tip of the mitral leaflets
8) Repeat for systole when convenient

The image below is a typical greyscale M-mode recording of the left ventricle in the parasternal long axis view with:

– The 2D reference image on top (red box)

– The M-mode recording at the bottom (yellow box)

Because M-mode is a one dimensional display it has a very high time (temporal) resolution

It is important to understand that M-mode provides no spatial information beyond the width of one ultrasound beam

Conversion of M-mode data to area or volume estimates should be done with caution

To collect the echocardiographic M-mode data in the parasternal long axis view (FATE position 3) the cursor line alternately transects:

– The left ventricle (1 red line)
– The anterior mitral leaflet (2 green line)
– The aorta and left atrium (3 blue line)

The image below shows a typical M-mode recording of the left ventricle in the parasternal long axis view with:

– 2D reference image on top (red box)

– M-mode recording at the bottom (yellow box)

Notice that the greyscale value is the same so that the white in the 2D image remains white in the M-mode recording and vice versa

Because the ultrasound is emitted from the top of the sector (red box) the anatomical structures close to the transducer are displayed at the top of each box and deeper structures are displayed closer to the bottom of each box (yellow and red)

As time is depicted along the horizontal axis dynamical changes can be observed

In this case 4 cardiac cycles are displayed

The images below show PSAX views of 4 hearts with hypovolaemia

Observe the small volume of the left ventricle in systole – almost emptying the ventricle
The walls of the LV touch each other
This pattern is often called “kissing ventricle”

The myocardial function is good, and the EF is high
EF alone is of no clinical value
Identification of the real problem/s (here hypovolaemia) is the solution

Keep this image in your mind, and when you recognise it in your patient think of hypovolaemia and treat the condition with volume or norepenephrine or both – not inotropes (beta-1 stimulation)