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Assessment of Cardiac Function

  • Amer M. Johri
Chapter

Abstract

Cardiac point-of-care ultrasound (POCUS) can be used to enhance the cardiac physical examination. POCUS of the heart may be useful in the assessment of ventricular systolic function, wall motion assessment, and disease states such as cardiomyopathy and pulmonary embolism [1]. In general, views obtained by POCUS are not meant to provide precise and accurate quantitative information such as quantified ejection fraction, pulmonary artery systolic pressure, and diastolic parameters; they can, however, provide an overall visual estimation of the severity of systolic dysfunction as well as be the initial screen for wall motion abnormality or cardiomyopathy. In this chapter, the initial views to obtain an assessment of ventricular function are introduced. It is critical for the operator to understand the need for adequate scanning training (hands-on image acquisition) and ongoing quality control to avoid false positive diagnosis [2]. As wall motion assessment is the most difficult skill in echocardiography, a skilled POCUS operator understands the limitations of her cardiac scan, and possesses the experience to know when formal echocardiography is indicated.

Keywords

Point-of-care ultrasound Left ventricle Parasternal long axis Parasternal short axis Four-chamber Contractility Cardiomyopathy Wall motion 

Notes

Acknowledgments

All videos courtesy of Atul Jaidka, MD.

Supplementary material

Video 17.1a

Demonstration of Parasternal long axis (PLAX) view of the left ventricle (LV) (MP4 80617 kb)

Video 17.1b

Demonstration of the Short axis (SAX) view of the left ventricle (LV) (MP4 158774 kb)

Video 17.1c

Demonstration of the four-chamber view of the heart (MP4 312689 kb)

Video 17.1d

Demonstration of point-of-care ultrasound setup on a VScan device (MP4 83043 kb)

Video 17.2a

Parasternal short axis view of the left ventricle demonstrating wall motion abnormality of the anteroseptal region (MP4 1964 kb)

Video 17.2b

Four-chamber view of the heart demonstrating wall motion abnormality extending into the septal region (MP4 1952 kb)

Video 17.3a

Parasternal long axis view of the left ventricle demonstrating left ventricular dilatation (MP4 1271 kb)

Video 17.3b

Short axis view of the left ventricle demonstrating left ventricular dilatation (MP4 1105 kb)

Video 17.4a

Parasternal long axis view demonstrating septal hypertrophy (MP4 2191 kb)

Video 17.4b

Four-chamber view demonstrating septal hypertrophy (MP4 2439 kb)

Video 17.5a

Parasternal long axis demonstrating a restrictive cardiomyopathy due to amyloid (MP4 2454 kb)

Video 17.5b

Subcostal view of the heart demonstrating restrictive cardiomyopathy, thickening of chamber walls (MP4 1653 kb)

Video 17.5c

Subcostal view demonstrating inferior vena cava (IVC) plethora (MP4 1312 kb)

Video 17.5d

Four-chamber view with focus on left ventricle demonstrating wall thickening due to amyloid (MP4 1684 kb)

Video 17.6a

Four-chamber view demonstrating right ventricular enlargement and impaired systolic function (MP4 1826 kb)

Video 17.6b

Parasternal long axis view demonstrating enlarged, hypokinetic right ventricle (MP4 2115 kb)

References

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    Wilkinson JS, Barake W, Smith C, Thakrar A, Johri AM. Limitations of condensed teaching strategies to develop hand-held cardiac ultrasonography skills in internal medicine residents. Can J Cardiol. 2016;32(8):1034–7.CrossRefPubMedGoogle Scholar
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    Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2013;26(6):567–81.CrossRefPubMedPubMedCentralGoogle Scholar
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    Johri AM, Picard MH, Newell J, Marshall JE, King ME, Hung J. Can a teaching intervention reduce interobserver variability in LVEF assessment: a quality control exercise in the echocardiography lab. JACC Cardiovasc Imaging. 2011;4(8):821–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Amer M. Johri
    • 1
  1. 1.Department of Medicine, Division of CardiologyKingston General HospitalKingstonCanada

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