Parasternal long axis view with a severely reduced ejection fraction.
POCUS cardiac shows a badly reduced ejection fraction (EF). But what exactly are we looking at to determine the EF? Your eye should land on the anterior leaflet of the mitral valve in the parasternal long axis window. In diastole, that anterior leaflet opens and blood rushes into the left ventricle from the left atrium. But I thought we were talking about ejection fraction, isn’t that systole? Good question, here we’re using diastole as a surrogate for systole. If the anterior leaflet doesn’t open up very well, like in this case, your EPSS (E Point Septal Separation, the distance from tip of anterior leaflet of mitral valve to septal wall when the valve is open) is a longer distance. As a surrogate, we can say the systolic function is bad. It may be useful for junior emergency medicine docs to quantify this until they’re comfortable with eyeballing the EPSS.