Cardiac Output by Echo - INTENSIVE (2024)

Author: Tom Rozen
Peer reviewer: Lloyd Roberts

Measuring the cardiac output is straightforward, and relies on a few simple concepts which we review here:

  1. The Left Ventricular Outflow Tract (LVOT) is assumed to be roughlycircular. Measure a diameter and you can calculate the area of thecircle.
  2. Pulsed Wave Doppler (PW) through the same point, in the centre of the LVOT tells us how fast that blood is travelling at any time.
  3. The area under the curve then tells us how far the column of blood has been pushed. (Y axis is in m/sec, X axis in seconds, so the area under the curve will tell us how far the blood has moved travelling at these velocities for this amount of time.)
  4. Work out the volume of the cylinder – Multiply the area ofthe LVOT (acircle) by the length the blood travelsand you get the stroke volume (ie volume ejectedper beat)
  5. Thestroke volume multiplied by theheart rategives usthe cardiac output (expressed as L/Min).
  6. Divide the cardiac output by the body surface area and we get the Cardiac Index.

Summary of the required echo steps

Step 1

Measure theLVOT diameter (Parasternal long axis, 2D). Zoom into be accurate. Measure up to 0.5cm back from the aortic valve leaflet insertion points (on the ventricular side).

Step 2

Using pulse wave Doppler (PW) line up the LVOT in the apical views, using either the apical 5 chamber or the apical 3 chamber. Aim to be as close as possible to the aortic valve, but not into the area of flow acceleration.The flow of blood is laminar through the PW gate, which is why the all the velocities follow a narrow band and the PW waveform is not “filled in”.The PW gate should be 2-4mm.

Step 3

Obtain the PW waveform. To get themost accurate reading, move sample volume toward aortic valveuntil flow accelerates.Then move sample volumes slightly awayfrom the aortic valve, toward apex until laminar flow returns.

In a surface echo, the blood flows through the LVOTaway from the probe so the curve is below the line. It should look hollow if the blood has laminar flow. Trace along theedge of the modal velocity (the outside of the chin, not the beard of the waveform)to measure the area under the curve (theVelocity Time Integral – VTI expressedin cm).

References

(First published on Echopraxis by Tom Rozen on 20/02/2014; reviewed by Lloyd Roberts)

Echo & Ultrasound
Cardiac Output by Echo - INTENSIVE (2024)

FAQs

What is a normal cardiac output echo? ›

Normal cardiac output ranges from 5 to 6 liters per minute in a person at rest. While exercising, an athlete can have a cardiac output of more than 35 liters per minute. A non-athlete's cardiac output will be lower than an athlete's but higher than when the non-athlete is at rest.

What is a normal cardiac output? ›

Cardiac output in humans is generally 5-6 L/min in an at-rest to more than 35 L/min in elite athletes during exercise. HR is determined by signals from the sinoatrial node, which automatically depolarizes at an intrinsic rate of 60 to 100 times each minute.

What is a good echocardiogram result? ›

A normal EF is about 55-65 per cent. It's important to understand that “normal” is not 100 per cent. Measuring the EF helps your doctor to understand how well the heart is pumping. Generally an EF below 40 per cent is considered a sign that the heart is not pumping as well as it should.

How do you calculate cardiac output on an echocardiogram? ›

Work out the volume of the cylinder – Multiply the area of the LVOT (a circle) by the length the blood travels and you get the stroke volume (ie volume ejected per beat) The stroke volume multiplied by the heart rate gives us the cardiac output (expressed as L/Min).

What is abnormal cardiac output? ›

If your heart doesn't pump enough blood to supply your body and tissues, it could signal heart failure. Low output also could happen after you've lost too much blood, had a severe infection called sepsis, or had severe heart damage.

What is a normal cardiac output for heart failure? ›

With most types of heart failure, cardiac output is normal or lower than normal. People with high-output heart failure have a cardiac output of 8 liters (about 2 gallons) of blood per minute. A normal cardiac output is 5 to 6 liters (1.3 to 1.6 gallons) of blood per minute.

Is cardiac output good or bad? ›

Sufficient cardiac output helps keep blood pressure at the levels needed to supply oxygen-rich blood to your brain and other vital organs.

What are signs of decreased cardiac output? ›

Objective Data
  • Weak or irregular pulse.
  • Elevated blood pressure or heart rate.
  • Crackles in the lungs.
  • Fluid accumulation in the legs.
  • Increased heart rate.
  • Altered myocardial contractility.
  • Inotropic changes.
  • Diagnosis for Atrial Fibrillation.

What is low cardiac output? ›

Low cardiac output syndrome (LCOS) is a clinical condition that is caused by a transient decrease in systemic perfusion secondary to myocardial dysfunction. The outcome is an imbalance between oxygen delivery and oxygen consumption at the cellular level which leads to metabolic acidosis.

What does 60% mean in an echo report? ›

It's expressed as a percentage and indicates how much blood your heart pumps out with each contraction. For example, an ejection fraction of 60% means your heart is pumping 60% of your blood out of your left ventricle (its main pumping chamber) every time your heart beats.

What is normal ejection fraction for a 70 year old? ›

A normal heart's ejection fraction is between 55 and 70 percent. This indication of how well your heart is pumping out blood can help to diagnose and track heart failure.

What are the symptoms of an abnormal echocardiogram? ›

The most sensitive was shortness of breath with a sensitivity of 32 %. The most specific symptom was oedema of the ankles, feet, or legs, with a high specificity of 90 %. Oedema also had the highest positive predictive value (45 %) and negative predictive value (73 %) for an abnormal echocardiogram (Table 3).

What is the stroke volume on an echocardiogram? ›

Stroke volume is the amount of blood ejected into the aorta during systole. Stroke volume is calculated by measuring the Doppler flow in the aortic valve.

How do you solve cardiac output? ›

As we all know, Cardiac output is the total volume of blood that heart pumps every minute. The formula used to calculate cardiac output is given as CO = HR × SV.

What is a normal EF of low cardiac output? ›

A left ventricle (LV) ejection fraction of about 50% to 70% is categorized as normal. A mildly reduced LV ejection fraction is usually between 41% and 49%. A reduced LV ejection fraction is usually 40% or less.

What is a normal ejection fraction with age? ›

Even a healthy heart doesn't pump all the blood from the left ventricle in a single cycle. Therefore, an ejection fraction of 55 to 65% is considered normal.

What is a dangerously low ejection fraction? ›

A low ejection fraction (or low EF) is typically 45 or less and can be evidence of heart failure or cardiomyopathy (a disease of the heart muscle). The heart's ejection fraction (EF) refers to the amount – or percentage – of blood pumped (or ejected) out of the heart's left ventricle with each contraction.

Top Articles
Latest Posts
Article information

Author: Neely Ledner

Last Updated:

Views: 5374

Rating: 4.1 / 5 (42 voted)

Reviews: 89% of readers found this page helpful

Author information

Name: Neely Ledner

Birthday: 1998-06-09

Address: 443 Barrows Terrace, New Jodyberg, CO 57462-5329

Phone: +2433516856029

Job: Central Legal Facilitator

Hobby: Backpacking, Jogging, Magic, Driving, Macrame, Embroidery, Foraging

Introduction: My name is Neely Ledner, I am a bright, determined, beautiful, adventurous, adventurous, spotless, calm person who loves writing and wants to share my knowledge and understanding with you.