Quick Facts

Indications

Cardiac function assessment via POCUS is indicated for:

• Shock states of uncertain etiology
• Suspected heart failure
• Monitoring response to interventions
• Pre/post-procedure cardiac evaluation
• Risk stratification in acute presentations

Absolute Contraindications

• No specific contraindications beyond general POCUS limitations

Relative Contraindications

• None specific to cardiac function assessment

Procedure

Functional Assessment Technique

LEFT VENTRICULAR FUNCTION

1. Obtain and optimize standard views:
   • Parasternal Long Axis (PLAX)
   • Parasternal Short Axis (PSAX) at mid-papillary level
   • Apical four-chamber view
2. Identify end-diastolic frame (largest LV cavity size)
3. Identify end-systolic frame (smallest LV cavity size)
4. Compare cavity size reduction visually
5. Evaluate wall motion in all visible segments
6. Assess for uniform myocardial thickening during systole
7. Classify function based on visual estimation

RIGHT VENTRICULAR FUNCTION

1. Utilize apical four-chamber and subcostal views
2. Compare RV size to LV (normally RV 2/3 or less of LV size)
3. Assess RV free wall motion for thickening and excursion
4. Evaluate tricuspid annular movement if visible
5. Look for septal position and motion:
   • Normal: Septum curves toward RV
   • Abnormal: Flattening or bowing toward LV
6. Assess RV systolic function qualitatively

COMPREHENSIVE ASSESSMENT

1. Integrate findings from multiple views
2. Assess both systolic and diastolic function when possible
3. Evaluate structural abnormalities that may affect function
4. Correlate with clinical presentation and vital signs

Function Assessment Details

LEFT VENTRICULAR SYSTOLIC FUNCTION

Assessment Methods

• Visual estimation:
  • “Eyeballing” technique (most common in POCUS)
  • Compare end-diastolic to end-systolic volumes
  • Evaluate endocardial excursion
• Classification system:
  • Normal: EF >55% (vigorous contraction)
  • Mild dysfunction: EF 45-54% (reduced contraction)
  • Moderate dysfunction: EF 30-44% (obviously reduced)
  • Severe dysfunction: EF <30% (minimal contraction)

Wall Motion Assessment

• Regional abnormalities:
  • Evaluate in multiple views
  • Describe location using standard segments
  • Classify as normal, hypokinetic, akinetic, or dyskinetic
• Global function:
  • Overall contractility assessment
  • Chamber size relationship to function
  • Wall thickness evaluation

RIGHT VENTRICULAR FUNCTION

Assessment Approach

• Size and shape:
  • Normal: RV ≤2/3 size of LV, triangular shape
  • Dilated: RV >2/3 size of LV, rounded shape
  • Severely dilated: RV equal to or larger than LV
• Function evaluation:
  • Free wall motion and thickening
  • TAPSE (Tricuspid Annular Plane Systolic Excursion) if measured
  • Interventricular septal motion and position

Signs of RV Dysfunction

• Pressure overload:
  • RV hypertrophy
  • Septal flattening in systole
  • D-shaped left ventricle in short axis
• Volume overload:
  • RV dilation
  • Septal flattening throughout cardiac cycle
  • Reduced RV systolic function

DIASTOLIC FUNCTION CLUES

Limited POCUS Assessment

• Indirect signs:
  • Left atrial enlargement
  • LV hypertrophy
  • IVC dilation with reduced respiratory variation
• Clinical correlation:
  • Preserved EF with heart failure symptoms
  • Signs of elevated filling pressures
  • Note: formal diastolic assessment typically requires spectral Doppler

Confirmation Methods

MULTI-VIEW ASSESSMENT

• LV function confirmation:
  • Assess in at least two different views
  • PLAX and PSAX provide complementary information
  • Apical view offers four-chamber perspective
• RV function confirmation:
  • Apical and subcostal views most useful
  • Both size and function assessment
  • Septal position evaluated in multiple views
• Correlation across views:
  • Consistent findings increase confidence
  • Discrepancies require further evaluation
  • Technical limitations should be noted

CLINICAL INTEGRATION

• Correlation with vital signs:
  • Blood pressure
  • Heart rate
  • Respiratory status
• Physical examination findings:
  • Jugular venous distention
  • Pulmonary examination
  • Peripheral edema
• Hemodynamic impact assessment:
  • Evidence of end-organ perfusion
  • Response to interventions
  • Overall clinical picture

Documentation Requirements

• Qualitative assessment of ventricular function
• Chamber size relationships
• Wall motion abnormalities if present
• Integration with clinical presentation
• Views utilized for assessment
• Technical limitations encountered
• Relevant secondary findings (effusion, valve abnormalities)

Quick Resources

Key Measurements

• Normal LV ejection fraction: >55%
• Normal RV:LV ratio: ≤0.6
• Normal septal motion: Toward RV in systole
• Normal LV wall thickening: >30% in systole

Key Images/Diagrams

Function Assessment

• Wall motion segment diagram
• EF visual estimation reference
• RV pressure vs. volume overload patterns
• Normal vs. abnormal cavity reduction

Pathology Recognition

• Regional wall motion abnormality patterns
• D-shaped LV in RV pressure overload
• Global dysfunction appearance
• Visual EF estimation guide

Reference Materials

• Normal vs. reduced EF comparison
• Regional wall motion abnormality examples
• RV dysfunction patterns
• Classification system reference

References