The RV and LV measurements: Important (Editorial)

I am an echocardiographer that learned to perform echos the old fashioned way with pink paper that had to be cut with scissors and measured by compass and ruler.  I was taught by one of the grumpiest people on the planet at the time (He Who Will Not Be Named).  I am a purest, in that I prefer M-Mode to two-D measurements because of superior temporal resolution, and reproducibility.  I will make 2-D measurements when I must.  The biggest mistake made by the echocardiographer in measuring the RV-LV is 1) including the moderator band in the IVS measurement, and 2) including chordae or papillary muscles in the LVPW measurements in diastole.  Classic M-Mode indicates that the measurement be made at the level of the chordae.  Many echocardiographers are lax on where the measurement is made.  The most common of all echo mistakes made are giving a patient some form of hypertrophic disease, namely, LVH.  This is serious because it will go into insurance files, and may result in improper classification of the patients medical health.  At worst, it could be cause for a referral for more costly testing, unnecessary medications, and needless expenses.  As a practicing sonographer, and a teacher, I stress the value of always reviewing measurements before an image is saved.  To be honest, I have had my share of negative ejection fractions because I was in a hurry.  The message is always check your calculations before you snap an image, or worse, let the patient go.  Peace.  TJW

BTW  Thanks everyone who has visited Echoworld.  I am looking for co-authors to help write material for this blog.