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LV pathology guides for echocardiography
Each guide explains what to look for, which views show it best, the typical 17-segment pattern and EF range, and common pitfalls. Every guide links to a live simulated example.
| Pattern | What to look for |
|---|---|
| Normal LV | Every segment moves inward and thickens: normal myocardium thickens by more than 40–50% in systole. |
| Hyperdynamic LV | Near-obliteration of the cavity at end-systole, brisk thickening everywhere, EF above the normal range (about 70% or more: ASE upper limits 72% in men and 74% in women; BSE has no separate hyperdynamic category, ≥55% is normal). |
| Coronary-territory RWMA (ischaemia / infarction) | An area that does not thicken, following a coronary territory. |
| LV aneurysm (post-infarct) | A thin, bright segment that is deformed in diastole as well as systole and bulges outward as the rest of the ventricle contracts. |
| Infarct with LV thrombus | An echo-dense mass at the apex over an akinetic or aneurysmal segment. |
| Dilated cardiomyopathy / global hypokinesia | A big, spherical ventricle with normal or thin walls and reduced thickening everywhere. |
| Takotsubo (stress) cardiomyopathy | A circumferential abnormality that crosses coronary territories (for example all apical segments) with hyperkinetic remaining segments. |
| LBBB dyssynchrony | An early, quick inward "flash" of the septum, then paradoxical motion as the lateral wall contracts late, with the apex rocking from septum to lateral. |
| RV pacing dyssynchrony | Similar to LBBB: abnormal activation from the RV apex, with a pacing spike before a broad QRS on the ECG. |
| Post-cardiac-surgery septal motion | After cardiac surgery the whole heart swings anteriorly in systole, so the septum appears to move the "wrong" way while it thickens normally. |
| RV pressure overload (systolic D-shape) | Systolic D-shape: in PSAX the septum is flattest at end-systole and often stays flattened into diastole; volume overload flattens it in diastole only (eccentricity index abnormal above 1.1). |
| RV volume overload (diastolic D-shape) | Diastolic D-shape: the septum flattens at end-diastole only and the LV becomes round again at end-systole (eccentricity index above 1.1 at end-diastole), so the septum moves paradoxically toward the RV in systole. |
| Combined RV pressure and volume overload (D-shape in systole and diastole) | D-shape in systole and diastole: the septum stays flattened throughout the cycle (eccentricity index above 1.1 at end-diastole and end-systole). |
| Concentric LV hypertrophy | Uniformly thick walls (septum above 12 mm in men or 11 mm in women; inferolateral wall above 12 mm; concentric when relative wall thickness exceeds 0.42), a normal or small cavity and normal or vigorous radial function. |
| Hypertrophic cardiomyopathy (asymmetric septal) | Asymmetric septal hypertrophy (maximal wall thickness ≥15 mm, much thicker than the inferolateral wall), small hyperdynamic cavity, often SAM of the anterior mitral leaflet in mid-systole.. |
| LV hypertrabeculation (non-compaction) | A thick spongy layer of trabeculations with deep recesses at the apex and lateral wall, over a thin compacted layer (2 at end-systole">non-compacted to compacted ratio >2 at end-systole). |