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Dilated cardiomyopathy and global hypokinesia on echo

A big, spherical ventricle with normal or thin walls and reduced thickening everywhere. Small mitral valve opening (low stroke volume) and often an enlarged LA and functional mitral regurgitation.

Watch it in the simulator →Practise random cases

Where to look

Apical 4-chamber (sphericity, dilated cavity), PLAX (LV diameters) and PSAX (globally reduced thickening).

Typical wall-motion pattern

Right ventricleRV1. Basal anterior — Hypokinetic12. Basal anteroseptal — Hypokinetic23. Basal inferoseptal — Hypokinetic34. Basal inferior — Hypokinetic45. Basal inferolateral — Hypokinetic56. Basal anterolateral — Hypokinetic67. Mid anterior — Hypokinetic78. Mid anteroseptal — Hypokinetic89. Mid inferoseptal — Hypokinetic910. Mid inferior — Hypokinetic1011. Mid inferolateral — Hypokinetic1112. Mid anterolateral — Hypokinetic1213. Apical anterior — Hypokinetic1314. Apical septal — Hypokinetic1415. Apical inferior — Hypokinetic1516. Apical lateral — Hypokinetic1617. Apex (apical cap) — Hypokinetic17ANTINFSEPLAT
4C3. Basal inferoseptal — Hypokinetic39. Mid inferoseptal — Hypokinetic914. Apical septal — Hypokinetic1417. Apex (apical cap) — Hypokinetic1716. Apical lateral — Hypokinetic1612. Mid anterolateral — Hypokinetic126. Basal anterolateral — Hypokinetic6Right ventricleRVSEPLAT2C4. Basal inferior — Hypokinetic410. Mid inferior — Hypokinetic1015. Apical inferior — Hypokinetic1517. Apex (apical cap) — Hypokinetic1713. Apical anterior — Hypokinetic137. Mid anterior — Hypokinetic71. Basal anterior — Hypokinetic1INFANT3C5. Basal inferolateral — Hypokinetic511. Mid inferolateral — Hypokinetic1116. Apical lateral — Hypokinetic1617. Apex (apical cap) — Hypokinetic1713. Apical anterior — Hypokinetic138. Mid anteroseptal — Hypokinetic82. Basal anteroseptal — Hypokinetic2Right ventricleRVINF-LATANT-SEPSAX baseRight ventricleRV1. Basal anterior — Hypokinetic12. Basal anteroseptal — Hypokinetic23. Basal inferoseptal — Hypokinetic34. Basal inferior — Hypokinetic45. Basal inferolateral — Hypokinetic56. Basal anterolateral — Hypokinetic6SAX midRight ventricleRV7. Mid anterior — Hypokinetic78. Mid anteroseptal — Hypokinetic89. Mid inferoseptal — Hypokinetic910. Mid inferior — Hypokinetic1011. Mid inferolateral — Hypokinetic1112. Mid anterolateral — Hypokinetic12

Example: Dilated, globally hypokinetic LV

Hypokinetic: all 17 segments

EF in this example: 29% (Severely impaired (≤35%)).

1 Normal2 Hypokinetic3 Akinetic4 Dyskinetic5 Aneurysmal

Ejection fraction

Across 24 simulated cases of this pattern the true EF ranged from 16% to 36% (median 24%, Severely impaired (≤35%)). Every case in the simulator is different, so practise until your visual estimate lands in the right 5% range.

Teaching points

Common pitfalls

Do not over-call a coronary territory when all segments are reduced; judge the overall distribution.

Try it now: open the Dilated cardiomyopathy / global hypokinesia example with the segment overlay, then test yourself in Practice where cases are random and graded against the exact answer.

Other patterns