Facts
Visible intracavitary thrombolus is not a frequent sign in pulmunary embolism – but if it is present it is highly specific and associated with high risk.
Visible intracavitary thromboembolus can be seen both in the right atrium and right ventricle.
Tips
Patients with symptoms of pulmonary embolism and visible intracavitary thromboembolus should be triaged directly to invasive heart center.
From the parasternal long axis view, these parameters regarding left ventricular systolic function can be assessed:
Video clips from the subcostal four-chamber view
Please note the
From the PSAX view, this parameter regarding left ventricular systolic function can be assessed:
Video clips of the PSAX view
Notice:
In the PSAX view, it is not possible to assess longitudinal function or mitral valve opening.
However, with good image quality, the PSAX view is excellent for assessing reduction in myocardial thickening and endocardial movement as in A-D.
From the subcostal view, these parameters regarding left ventricular systolic function can be assessed:
Parameters
Combining the parameters of myocardial thickness/endocardial movement, valve movement and longitudinal function provides excellent information regarding left ventricular systolic function.
Views
This can be done from all cardiac views, some providing more information on the individual parameter than others.
The video below is showing all three parameters that have just been explained: Myocardial thickening, (blue) movement of the mitral valve leaflets (red) and longitudinal excursion of the annular plane (green).
Facts
Eyeballing of left ventricular systolic function in the emergency setting is an overall estimation based on three primary parameters:
Facts
The left ventricle contracts like wringing out a cloth and the contraction does not only consist of endocardial movement towards the center of the lumen, but also of longitudinal contraction.
Longitudinal contraction is eyeballed by observing the movement of the hyperechoic mitral annulus towards the apex (displayed with green color in the clip below).
Tips
A normal longitudinal function (movements of the mitral annulus >11 mm) generally rules out reduced left ventricular systolic function.
Because of the hyperechogenic structure of the mitral annulus, longitudinal contraction can often be assessed even though image quality is low.
Facts
Reduced systolic function and lower stroke volume means less filling of the ventricle in the following diastole.
Lower flow velocities of blood into the left ventricle mean less diastolic opening movement of the mitral valve leaflets (marked with red color in the clip below).
Tips
With normal left ventricular systolic function, the diastolic filling flow causes the anterior mitral valve leaflet tip to come within 1 cm of separation from the septum.
With reduced systolic function that separation increases.
