Link To And Excerpts From “POCUS Cases 8 – LV Dysfunction”

Posted on May 4, 2020 by Tom Wade MD

In this post I link to and excerpt from POCUS Cases 8 – LV Dysfunction, [Link is to the video] from POCUS Cases from Emergency Medicine Cases.

Learning Objectives

  1. To review the evidence for accuracy of non-radiologists in assessing for LV dysfunction
  2. To review the 3 main features of LV function on POCUS
  3. To understand the caution of chronic LV dysfunction in assessing acute LV function on POCUS

Here are excerpts:

When is cardiac POCUS indicated:

  • Exertional SOB or chest pain
  • Unexplained hypotension
  • Unexplained SOB
  • Clinical findings of overload.

Cardiac Views:

  1. Subxiphoid view
    1. Easy to obtain
    2. Most accurate for pericardial effusion
    3. Not good for determining LV dysfunction
  2. Parasternal Long Axis (PSL)
    1. Also good for pericardial effusion
    2. Great for assessing cardiac LV dysfunction
  3. Parasternal Short Axis (PSS)
    1. RV strain and global contraity
    2. Not good for determining LV dysfunction
  4. Apical Four Chamber (A4C)
    1. Good for assessing RV strain and LV function

Three Features of LV Cardiac Function That Can Be Seen on the PSL and A4C Views

  1. Mitral Valve Movement
    1. The closer the anterior leaflet comes to the septum the better the contractility
    2. < 1 cm = normal
  2. LV Size
    1. The more dilated the more abnormal
    2. < 5 cm = normal
  3. LV Contractility
    1. Contracting by 1/3rd = normal

Chronic LV Dysfunction

  1. Patient may have chronic LV dysfunction that is not responsible for the patient’s current sysmptoms.
    1. Compare the current POCUS with previous echocardiograms if available.
    2. Clinical Correlations
      1. Are today’s symptoms consistent with today’s POCUS (for example, a cough)
    3. Use other POCUS exams
      1. Lung POCUS showing widespread B-lines would be consistent with acute LV dysfunction or acute exacerbation of chronic LV dysfunction as would pleural effusions.

Summary and Pearls

  • Subxiphoid and short axis will not be helpful to assess LV function.
  • Using the PSL and the A4C views to look for:
    • Mitral valve movement
    • Size of the LV
    • Contractility of the LV
  • If people have chronic LV dysfunction, they will have an abnormal LV
    • Clinical Correlation is required.

 

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