The EF equation entails:

– That reduced diastolic chamber dimension (reduced EDV) will alter EF – progressive blood loss will often reduce EDV and thus increase the EF

– When EF increases – under these circumstances – the stroke volume will decrease concomitantly

– Thus the EF can go up to almost 100% without providing any clinically useful information about myocardial deformation or adequacy of circulation

– Recognition of the hypovolaemic state is the key to understanding and solving the problem in these patients

Eyeballing is a simple visual qualitative method to evaluate the overall function of the heart chambers

All imaging views can be used for the eyeballing and combined information from different views is recommended

The result of eyeballing the 4 basic FATE views below is normal ventricular function of all chambers

M-mode is an abbreviation of

It is important to notice that different pathologies may confound the interpretation of left ventricular systolic function

For example:

– Pericardial effusion (A)
– Adjacent chamber dilatation (B)
– Left ventricular dilatation (C)
– Hypovolaemia (D)

Diastolic cardiac function describes the filling of the ventricles

Impaired diastolic function – also known as diastolic dysfunction – is characterised by reduced filling of the ventricles despite increased filling pressure

As diastolic impairment induces stiffness of the left ventricle, reduced systolic function often accompanies diastolic dysfunction especially as reduced longitudinal deformation

2D ultrasound characteristics of left ventricular diastolic dysfunction are:
– Left ventricular myocardial hypertrophy and concomitant reduced LV cavity size
– Enlarged left atrium (the enlargement is proportional to the severity of the diastolic dysfunction)

Ejection fraction (EF) is considered the gold standard for assessment of left ventricular systolic function in daily clinical practice

EF can be reported either qualitatively or semi-quantitatively

Simple qualitative judgment:
– Eyeballing – probably the most commonly used method for assessment of EF
– EF is normal or reduced (mildly, moderately or severely)

Quantitative and semi-quantitative assessment of dynamic changes during the cardiac cycle:
– Fractional shortening (FS), mitral septal separation (MSS), mitral annular plane systolic excursion (MAPSE)

The images below are explained in the following topics

Several methods exist for the measurement of EF, with eyeballing as the most frequently used method

A high EF is not a bullet proof marker of adequate circulation, because certain clinical circumstances can impact the circulation dramatically without reducing the calculated value of the EF

EF is solely a measure of the LV function, and not a measure of adequate circulation

EF does not take into account the importance of pathological conditions that impair circulation

Several life-threatening pathological conditions – where the myocardial deformation is normal – may invalidate the EF as a measure of the adequacy of circulation

Before you start scanning, ask yourself:

1. Which position – 1, 2, 3 or 4?
2. How should I hold the probe?
3. Where should the orientation marker (OM) be pointing to?
4. What should appear on the screen?

Holding the probe in your right hand:

1. Apply gel without touching the footprint of the probe with the gel dispenser
2. Place the transducer on the chest wall where you expect to get the desired image
3. Circle with your hand until you recognise any anatomical structures on the screen
4. Then optimise the image in only one plane at a time by rotating / tilting / sliding

Anatomy

You have now learned:

– The anatomy of the FATE position 4 – the pleural view on the patient’s right and left side

– How to obtain the correct image with respect to transducer orientation and the relationship to the presentation on the screen

Review this lesson if you are not confident about how to obtain the view and identify the structures

When you feel confident move on to the next lesson concerning cardiac function

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

First the systolic and diastolic ventricular function is covered

Next we will look at the ventricles individually

The following terms will be explained:
– Ejection fraction (EF)
– Eyeballing
– Fractional shortening (FS)
– Mitral septal separation (MSS)
– MAPSE = Mitral Annular Plane Systolic Excursion (LV)
– TAPSE = Tricuspid Annular Plane Systolic Excursion (RV)
– Myocardial and cardiac chamber dimensions