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Normal LV function on echocardiography

Every segment moves inward and thickens (normal systolic thickening is roughly 40% or more). The mitral annulus moves about 1.2–1.6 cm toward the apex (MAPSE; below 10 mm suggests reduced longitudinal function). The apex itself barely moves; the base does the travelling.

Watch it in the simulator →Practise random cases

Where to look

All views. In apical views compare the base, which travels toward the apex, with the near-stationary apex; in PSAX check that every segment of the ring thickens symmetrically.

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: Normal LV size and function

All 17 segments thicken normally.

EF in this example: 61% (Normal (≥55%)).

1 Normal2 Hypokinetic3 Akinetic4 Dyskinetic5 Aneurysmal

Ejection fraction

Across 24 simulated cases of this pattern the true EF ranged from 60% to 68% (median 64%, 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

Apical foreshortening and near-field clutter can make a normal apex look akinetic. Check that the apex thickens.

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

Other patterns