Cardiovascular Health
Cardiovascular Health
This domain tests basic echocardiography and vascular screening: chamber size, LV systolic function, valves, aorta, and carotid.
Core rules
- Parasternal long axis: RV anterior, LV posterior, aortic root, left atrium. Measure the aortic root at the sinuses of Valsalva; measure LV dimensions at the chordal level, perpendicular to the long axis.
- Avoid foreshortening: the LV apex should be a true apex, not a rounded truncation, and the aortic and mitral valves should align.
- Eyeball EF: normal >55%; mildly reduced 45-54%; moderately 30-44%; severely <30%. Use multiple views.
- Aorta: abdominal aortic diameter ≥3 cm is an aneurysm; screen with a curvilinear probe in transverse and longitudinal, outer wall to outer wall.
- Carotid: keep the Doppler angle ≤60°; an ICA/CCA PSV ratio >4 suggests ≥70% stenosis, but don't rely on one parameter.
Worked example
PSLAX shows a rounded LV apex and a short long axis. That is foreshortening: move one intercostal space and tilt toward the apex, then re-measure at the chordae. If EF still looks low in two views, report a range and recommend formal echocardiography.
Traps
Measuring the aortic root off-axis; calling severe MR from color jet area alone; using the wrong Nyquist scale; measuring the aorta inner-to-inner; ignoring angle in carotid Doppler.