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Instructor Top Tips: Echocardiography - Intermediate/Advanced

Here, some of the instructors from the point of care echocardiography workshop at the SONIC Conference, share their top tips for the skills they were teaching.

RV Function - TAPSE

By Kellie D’Orsa

  • ASE suggest using the standard Apical 4 chamber window when assessing RV function

  • Option to zoom or decrease sector size or depth to focus on RV

  • Align m.mode cursor parallel to motion of lateral TV annulus

  • Slightly decrease overall gains

  • TAPSE is a distance measurement not a slope or time measurement (minimum to max excursion).

  • TAPSE < 17mm highly suggestive of RV dysfunction.


By Dr Allan Whitehead

1. Qualitative/Eyeball assessments of LV function in both unstable and stable patients are valid

2. Have multiple methods for doing assessment of LV function eg EPSS, LV cavity size change, MAPSE and you don't have to measure

3. Know the limitations of your chosen methods of assessing LV function

4. LV function assessment doesn't have to be precise ie within 5% of true EF. Calling it normal, mildly impaired (ie 40-50% EF) severely impaired (30% EF or less) is fine

Protocols for shocked patient

By Dr Rachel Liu

  • Your main answer is in the cardiac part of the protocols

  • Although you should learn in order, no need to apply that order clinically depending on patient presentation and external factors

  • Choose 1 protocol you like the best and stick with it

Measuring Cardiac Output

By Dr Jon Theoret

1) Use Pulse Wave Doppler to measure velocities at a precise location, as long as they are less than 1.2 m/s

2) To obtain apical 5 chambers view, start with apical 4 chamber view and angle the ultrasound beam towards patient’s head

3) For precise measurements, use Zoom function - remember to maintain a stable image

4) When making Doppler measurements, ensure that you have well-defined complexes. Let 5-10 cardiac cycles elapse before freezing the image


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