<br />
Ultrasound<br />
Focused echo – assessment<br />
of LV function in the ED<br />
Philips tutorial<br />
Dale Quirke, MD<br />
Wake Emergency Physicians, Wake Medical Hospital, Raleigh, North Carolina<br />
Anthony J. Weekes, MD, RDCS, RDMS<br />
Director, Emergency Ultrasound Fellowship, Carolinas Medical Center<br />
Associate Clinical Professor of Emergency Medicine<br />
University of North Carolina, Chapel Hill<br />
Contents<br />
Focused echo – assessment of LV function in the ED<br />
1 Introduction 3<br />
2 Assessment of LV function using 2D 9<br />
3 Interpretation 14<br />
4 LVH and cardiomyopathies 22<br />
5 M-mode for the assessment<br />
of LV function 25<br />
6 E-Point Septal Separation (EPSS) 28<br />
7 Fractional Shortening (FS) <a title="Focused echo - assessment of LV function in the ED page 1" href="http://viewer.zmags.com/publication/5737c268?page=1"> Ultrasound Focused echo – assessment of LV func</a>
<a title="Focused echo - assessment of LV function in the ED page 2" href="http://viewer.zmags.com/publication/5737c268?page=2"> Contents Focused echo – assessment of LV functi</a>
<a title="Focused echo - assessment of LV function in the ED page 3" href="http://viewer.zmags.com/publication/5737c268?page=3"> 1 Introduction Echocardiography at the</a>
<a title="Focused echo - assessment of LV function in the ED page 4" href="http://viewer.zmags.com/publication/5737c268?page=4"> Prior to the availability of ultrasound in the ED</a>
<a title="Focused echo - assessment of LV function in the ED page 5" href="http://viewer.zmags.com/publication/5737c268?page=5"> The ACEP 2006 Emergency Ultrasound Imaging Criter</a>
<a title="Focused echo - assessment of LV function in the ED page 6" href="http://viewer.zmags.com/publication/5737c268?page=6"> Additionally, the American College of Cardiology/</a>
<a title="Focused echo - assessment of LV function in the ED page 7" href="http://viewer.zmags.com/publication/5737c268?page=7"> In another study by Randazzo et al., the research</a>
<a title="Focused echo - assessment of LV function in the ED page 8" href="http://viewer.zmags.com/publication/5737c268?page=8"> This tutorial focuses specifically on the POC ech</a>
<a title="Focused echo - assessment of LV function in the ED page 9" href="http://viewer.zmags.com/publication/5737c268?page=9"> 2 Assessment of LV function using 2D </a>
<a title="Focused echo - assessment of LV function in the ED page 10" href="http://viewer.zmags.com/publication/5737c268?page=10"> Parasternal long-axis (PSLA) view The parasternal</a>
<a title="Focused echo - assessment of LV function in the ED page 11" href="http://viewer.zmags.com/publication/5737c268?page=11"> Parasternal short-axis (PSSA) view To obtain a st</a>
<a title="Focused echo - assessment of LV function in the ED page 12" href="http://viewer.zmags.com/publication/5737c268?page=12"> Apical four-chamber view The apical four-chamber </a>
<a title="Focused echo - assessment of LV function in the ED page 13" href="http://viewer.zmags.com/publication/5737c268?page=13"> Subcostal view The transducer is placed in the su</a>
<a title="Focused echo - assessment of LV function in the ED page 14" href="http://viewer.zmags.com/publication/5737c268?page=14"> 3 Interpretation 2D imaging for the assessm</a>
<a title="Focused echo - assessment of LV function in the ED page 15" href="http://viewer.zmags.com/publication/5737c268?page=15"> Things to consider when assessing LV function · </a>
<a title="Focused echo - assessment of LV function in the ED page 16" href="http://viewer.zmags.com/publication/5737c268?page=16"> [Figure 5a (diastole) and 5b (systole)] Still fra</a>
<a title="Focused echo - assessment of LV function in the ED page 17" href="http://viewer.zmags.com/publication/5737c268?page=17"> [Figure 7a (diastole) and 7b (systole)] Still fra</a>
<a title="Focused echo - assessment of LV function in the ED page 18" href="http://viewer.zmags.com/publication/5737c268?page=18"> [ Video 1 ] Norm</a>
<a title="Focused echo - assessment of LV function in the ED page 19" href="http://viewer.zmags.com/publication/5737c268?page=19"> [ Video 2 ] Mode</a>
<a title="Focused echo - assessment of LV function in the ED page 20" href="http://viewer.zmags.com/publication/5737c268?page=20"> [ Video 3] Sever</a>
<a title="Focused echo - assessment of LV function in the ED page 21" href="http://viewer.zmags.com/publication/5737c268?page=21"> The measurement of ejection fraction (EF) with co</a>
<a title="Focused echo - assessment of LV function in the ED page 22" href="http://viewer.zmags.com/publication/5737c268?page=22"> 4 LVH and cardiomyopathies During the routin</a>
<a title="Focused echo - assessment of LV function in the ED page 23" href="http://viewer.zmags.com/publication/5737c268?page=23"> Young patients presenting with syncope in whom th</a>
<a title="Focused echo - assessment of LV function in the ED page 24" href="http://viewer.zmags.com/publication/5737c268?page=24"> Dilated cardiomyopathy Dilated cardiomyopathy is </a>
<a title="Focused echo - assessment of LV function in the ED page 25" href="http://viewer.zmags.com/publication/5737c268?page=25"> 5 M-mode for the assessment of LV functio</a>
<a title="Focused echo - assessment of LV function in the ED page 26" href="http://viewer.zmags.com/publication/5737c268?page=26"> One of the more common applications of M-mode is </a>
<a title="Focused echo - assessment of LV function in the ED page 27" href="http://viewer.zmags.com/publication/5737c268?page=27"> [Figure 11] M-mode of the mitral valve. Note the </a>
<a title="Focused echo - assessment of LV function in the ED page 28" href="http://viewer.zmags.com/publication/5737c268?page=28"> 6 E-Point Septal Separation (EPSS) The dis</a>
<a title="Focused echo - assessment of LV function in the ED page 29" href="http://viewer.zmags.com/publication/5737c268?page=29"> [Figure 12] M-mode of the mitral valve demonstrat</a>
<a title="Focused echo - assessment of LV function in the ED page 30" href="http://viewer.zmags.com/publication/5737c268?page=30"> [Figure 12b] M-mode of the mitral valve demonstra</a>
<a title="Focused echo - assessment of LV function in the ED page 31" href="http://viewer.zmags.com/publication/5737c268?page=31"> Important things to remember · Valvular dysfunct</a>
<a title="Focused echo - assessment of LV function in the ED page 32" href="http://viewer.zmags.com/publication/5737c268?page=32"> [ Video 4 ] Note</a>
<a title="Focused echo - assessment of LV function in the ED page 33" href="http://viewer.zmags.com/publication/5737c268?page=33"> 7 Fractional shortening (FS) Just as EPSS</a>
<a title="Focused echo - assessment of LV function in the ED page 34" href="http://viewer.zmags.com/publication/5737c268?page=34"> The analysis package on the ultrasound system wil</a>
<a title="Focused echo - assessment of LV function in the ED page 35" href="http://viewer.zmags.com/publication/5737c268?page=35"> [Figure 13a] Fractional shortening using an M-mod</a>
<a title="Focused echo - assessment of LV function in the ED page 36" href="http://viewer.zmags.com/publication/5737c268?page=36"> [Figure 13b] Fractional shortening. M-mode tracin</a>
<a title="Focused echo - assessment of LV function in the ED page 37" href="http://viewer.zmags.com/publication/5737c268?page=37"> [Figure 13c] Fractional shortening: common error.</a>
<a title="Focused echo - assessment of LV function in the ED page 38" href="http://viewer.zmags.com/publication/5737c268?page=38"> 8 Pulsed wave Doppler for the ass</a>
<a title="Focused echo - assessment of LV function in the ED page 39" href="http://viewer.zmags.com/publication/5737c268?page=39"> Systole Diastole Systole Dias</a>
<a title="Focused echo - assessment of LV function in the ED page 40" href="http://viewer.zmags.com/publication/5737c268?page=40"> In patients with diastolic dysfunction, impaired </a>
<a title="Focused echo - assessment of LV function in the ED page 41" href="http://viewer.zmags.com/publication/5737c268?page=41"> [Figure 14b] Pulsed wave Doppler. Note the 2D ref</a>
<a title="Focused echo - assessment of LV function in the ED page 42" href="http://viewer.zmags.com/publication/5737c268?page=42"> [Figure 14c] Diastolic dysfunction. This is a pul</a>
<a title="Focused echo - assessment of LV function in the ED page 43" href="http://viewer.zmags.com/publication/5737c268?page=43"> 9 Summary and clinical pearls In summary, </a>
<a title="Focused echo - assessment of LV function in the ED page 44" href="http://viewer.zmags.com/publication/5737c268?page=44"> Listed below are clinical pearls that should be c</a>
<a title="Focused echo - assessment of LV function in the ED page 45" href="http://viewer.zmags.com/publication/5737c268?page=45"> 10 Bibliography and references 1. Shoemaker </a>
<a title="Focused echo - assessment of LV function in the ED page 46" href="http://viewer.zmags.com/publication/5737c268?page=46"> Additional resources For additional resourc</a>
<a title="Focused echo - assessment of LV function in the ED page 47" href="http://viewer.zmags.com/publication/5737c268?page=47"> This paper reflects the opinion of the author, no</a>