Given Name:	Family Name:
Date of Birth:	Age:	Sex:	Hospital ID:
Referring Physician:	Reason for Echo:

Report

Acoustic Window:
Premedication
Diameter Aortic root (mm)	20-36 mm
Ascending Aorta (mm)
Diameter LA (mm)	19-40 mm	Volume LA (ml):
LV end-diastolic (LVEDD) mm	37-57 mm
LV end-systolic (LVESD) mm	27-37 mm
IV septal thickness (IV) mm	7-12 mm
Posterior wall thickness (PW) mm	7-12 mm
RV end-diastolic (RVESD) mm	(NV <30mm)
LV Fractional Shortening (FS)
LV-Ejection Fraction (EF)	Estimated:	Simpson’s rule:	Teicholz:	49-69 %
Mitral Valve anatomy	Opening:	Comment:
Mitral Velocity Ratio	E / A: (NV 1.5 ±0,5)	E’ vel.:	A´ vel.:	E’/A':
Mitral Valve M-Mode	EF-Slope: >70	Reduced:	EPSS (mm): (NV <6)
Mitral Valve Gradient	Pmean:
Mitral Valve area (cm2) (MVA)	PHT:	Planimtry:
Mitral Regurgitation (MR)	Grade (0-4 ):
Aortic Valve anatomy	Opening:	Comment:
Aortic Valve gradient	Jet Vel:	Pmax:	Pmean:
Aortic Valve area (cm2)	cont. equ.:	Planimetry:	EF/Pmax:
Aortic Regurgitation (AR)	Grade (0-4)	PHT:
Calc. syst . PA-Pressure (PA)	(NV <30mmHg,)	TAPSE:	(NV >17mm)
Pulmonic Valve	Jet Vel:	Gradient (mmHg):	Anatomy
Pericardium	Thickness (mm): (NV <2mm)	Fluid (diastole mm):
Inf. Vena Cava (IVC)	Diameter (mm): (NV <20mm)	Collapsibility: (>50%)
Principal Diagnosis:
Additional findings and final assessment:

Examining physician:	Create Date: Jun. 26, 18

Signature: