PAGE AUTHOR

MATT JONES, MD

 

CONSULTING SPECIALIST

DON BYARS, MD

 

IMAGE CONTRIBUTOR

MATT JONES, MD

 

 

Diagnostic TRANSTHORACIC ECHOCARDIOGRAPHY

 

 

 

 

Evaluation of left ventricular systolic function

gross assessment

  • left ventricular squeeze - approx 50%

  • EPSS - should be < 5mm

  • MAPSE - don't measure, look for good movement

If you want to measure 

  • Fractional Shortening

  • Teichholz

  • Modified Simpson (most accuarte)

 

 

End Point Septal Separation (EPSS)

 

 

IVC





 

Evaluation of Left Ventricular Diastolic Function

Think of diastolic function as how well the ventricles relax. Diastolic dysfunction (or stiffness) is most often a result of ventricular hypertrophy secondary to hypertension. Other causes include...

http://www.criticalecho.com/sites/default/files/images/6.13.png

https://www.youtube.com/watch?v=qdLkbcFe_DI

 

Supernormal Diastolic function

need example

 

Normal Diastolic Function

 

 

Diastolic dysfunction, Grade 1

(Abnormal relaxation)

 

diastolic dysfunction, grade 2 (pseudonormal)

 

 

diastolic dysfunction, grade 3 (restrictive)

Evaluation of Right Ventricle 

 

Gross Assessment of RV function

  • Observe for normal ventricular contraction. You want to see no free wall hypokinesis. 
  • RV dilation/enlargement, normal RV/LV basal diameter ratio 1/3 to 1/2 
  • Evidence of RV overload
    • Apical Blunting
    • Deviation of interventricular septum toward LV 
    • Dilated IVC

Doppler

  • Color Doppler 
    • Observe for tricuspid regurgitation 

Tricuspid Annular Plane Systolic Excursion (TAPSE) with M-mode

  •  TAPSE <1.6 cm is abnormal 

Right Ventricular Systolic Pressure (RVSP)

RVSP = 4[(TRmax)^2] + RAP 

Normal RSVP is 35mmhg 

TRmax is the max velocity of tricuspid regurgitation in m/s

RAP is Right Atrial Pressure 

To calculate Right Atrial Pressure

 

 

VTI

(Velocity Time integral)