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Hyperdynamic left ventricle on echo

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). Note the high heart rate.

Watch it in the simulator →Practise random cases

Where to look

PSAX at papillary level (cavity almost obliterated at end-systole, papillary muscles meeting) and apical 4-chamber.

Typical wall-motion pattern

Example: Hyperdynamic LV

All 17 segments thicken normally.

EF in this example: 74% (Normal (≥55%)).

1 Normal2 Hypokinetic3 Akinetic4 Dyskinetic5 Aneurysmal

Ejection fraction

Across 24 simulated cases of this pattern the true EF ranged from 72% to 78% (median 75%, Normal (≥55%)). Every case in the simulator is different, so practise until your visual estimate lands in the right 5% range.

Teaching points

Hyperdynamic: near-obliteration of the cavity at end-systole. Common with sepsis, hypovolaemia, anaemia or inotropes.
Atrial fibrillation: filling and EF vary from beat to beat. Average at least five beats, or use an index beat (one that follows two similar RR intervals), and avoid beats after a very short RR interval.
Ventricular ectopics: the premature beat is weak and dyssynchronous and the beat after the pause is stronger. Judge EF and wall motion on normal sinus beats only.

Common pitfalls

A small, vigorous ventricle can hide a small RWMA; look at each wall separately.

Try it now: open the Hyperdynamic LV example with the segment overlay, then test yourself in Practice where cases are random and graded against the exact answer.