The following topics will focus on how to obtain and interpret the 2D ultrasound images for:
Dilated, poorly functioning LV – typical clinical conditions
Consider a dilated and poor functioning left ventricle
In particular 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)
Dilated, poorly functioning LV
The 2D echocardiographic characteristics
Notice if:
– LV dimensions are increased
– Myocardial wall is thin
– Myocardial movement is reduced
– Mitral septal separation is increased
– Left atrium is often enlarged
– Mitral valve is incompetent
– Mitral annular plane systolic excursion (MAPSE) is reduced
Eyeballing
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 is, in the 4 basic FATE views beneath, normal ventricular function of all chambers
Eyeballing hypovolaemia
The images show PSAX views of 4 hearts with hypovolaemia
Observe the small volume of the left ventricle in systole – the ventricle is almost empty
The walls of the left ventricle touch each other
This pattern is often called “kissing walls”
The myocardial function is good, and the ejection fraction is high
Therefore, ejection fraction seen alone is of little 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
Introduction to basic cardiac pathology
Sonographic recognition of pathological conditions in realtime at the bedside facilitates good patient care
Ultrasound can visualize cardiac and pleural pathology directly and in real time at the bedside
Recognition of relevant pathology is a key competency in the FATE examination
You will now learn to recognize the relevant pathology using the standard FATE examination
Pleural view: Key points
The liver is used as the reference point when diaphragm and pleura on the patients right side are examined
The spleen is used as the reference point when diaphragm and pleura on the patients left side are examined
Evaluation of pleural effusion should always be performed with elevated thorax,
Systolic ventricular function
Evaluation of the systolic cardiac function with ultrasound is performed by assessing:
– Endocardial (and/or myocardial) movement, during systole
– Myocardial thickening during systole
The video shows a PSAX view of a heart with normal LV function
Notice the symmetrical endocardial movement towards the center of the LV and equivalent global and systolic myocardial thickening
XX 89 – Summary
You have now learned:
– The anatomy of the FATE position 4
– How to obtain the correct images with respect to transducer orientation and the relationship to the presentation on the screen
Review if you are not confident about how to obtain the views and identify the structures
When you feel confident move on to cardiac function and pathology
Position 4 and the FATE card
Page 1 on the FATE card is used for this part of the FATE examination
Position 4 is indicated on the FATE torso in the lower right corner of page 1 on the FATE card
The target image is displayed in the lower left corner of page 1 on the FATE card
Study the FATE card and memorize position 4 and the target image before beginning the examination