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Hyperdynamic left ventricle on echo

Near-obliteration of the cavity at end-systole, brisk thickening everywhere. 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

Right ventricleRV1. Basal anterior — Normal12. Basal anteroseptal — Normal23. Basal inferoseptal — Normal34. Basal inferior — Normal45. Basal inferolateral — Normal56. Basal anterolateral — Normal67. Mid anterior — Normal78. Mid anteroseptal — Normal89. Mid inferoseptal — Normal910. Mid inferior — Normal1011. Mid inferolateral — Normal1112. Mid anterolateral — Normal1213. Apical anterior — Normal1314. Apical septal — Normal1415. Apical inferior — Normal1516. Apical lateral — Normal1617. Apex (apical cap) — Normal17ANTINFSEPLAT
4C3. Basal inferoseptal — Normal39. Mid inferoseptal — Normal914. Apical septal — Normal1417. Apex (apical cap) — Normal1716. Apical lateral — Normal1612. Mid anterolateral — Normal126. Basal anterolateral — Normal6Right ventricleRVSEPLAT2C4. Basal inferior — Normal410. Mid inferior — Normal1015. Apical inferior — Normal1517. Apex (apical cap) — Normal1713. Apical anterior — Normal137. Mid anterior — Normal71. Basal anterior — Normal1INFANT3C5. Basal inferolateral — Normal511. Mid inferolateral — Normal1116. Apical lateral — Normal1617. Apex (apical cap) — Normal1713. Apical anterior — Normal138. Mid anteroseptal — Normal82. Basal anteroseptal — Normal2Right ventricleRVINF-LATANT-SEPSAX baseRight ventricleRV1. Basal anterior — Normal12. Basal anteroseptal — Normal23. Basal inferoseptal — Normal34. Basal inferior — Normal45. Basal inferolateral — Normal56. Basal anterolateral — Normal6SAX midRight ventricleRV7. Mid anterior — Normal78. Mid anteroseptal — Normal89. Mid inferoseptal — Normal910. Mid inferior — Normal1011. Mid inferolateral — Normal1112. Mid anterolateral — Normal12

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 73% 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

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.

Other patterns