Test yourself
EPSS: when the mitral valve misses the septum
5 questions. Pick an answer to see whether you are right and why. Your score appears at the end.
Question 1Where do you place the M-mode line to measure EPSS?
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Answer a. EPSS measures how close the anterior mitral leaflet comes to the septum. The parasternal long-axis view shows both in line with the beam, and M-mode through the leaflet tip records the E-point clearly. Measurements at the annulus or in other views answer different questions.
Question 2What does the E-point represent on the M-mode trace of the mitral valve?
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Answer b. In sinus rhythm the anterior leaflet opens twice in diastole: first with early passive filling, the E-point, then with atrial contraction, the A-point. The E-point is the taller first peak and the one you measure to the septum.
Question 3An adult has an EPSS of 14 mm. What does this suggest, if the view is good and the valves are normal?
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Answer d. A gap above about 7 mm supports reduced LV systolic function, and 14 mm is well above it. In a hypovolaemic, hyperdynamic heart the leaflet often comes very close to the septum. Confirm with a visual estimate of the whole ventricle.
Question 4Which condition makes EPSS read high even when left ventricular function is normal?
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Answer b. A regurgitant aortic jet strikes the anterior mitral leaflet in diastole and stops it opening fully, so the gap to the septum widens. Mitral stenosis does the same by restricting the leaflet. In both, EPSS overestimates LV impairment.
Question 5How should you use EPSS in a breathless patient?
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Answer d. EPSS is quick and objective, which makes it useful for new scanners. It reflects LV function indirectly and is affected by valve disease, septal thickness and the view. Combine it with what the whole ventricle is doing, and with the rest of the scan.
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Four or five delegates per instructor, FAMUS-accredited faculty and long, supervised time on the probe.
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