Appendix 4: Format for a Level 1 report

Each report must TYPED and contain a documented clinical question, a comprehensive report of Level
1 Echocardiographic findings and a conclusion integrating the above.

PLEASE NOTE – ALL REPORTS SUBMITTED IN THE LOGBOOK MUST BE ANONYMISED AS PER
APPENDIX 10.

Patient name Level 1 Echocardiogram report

MRN/NHS no

DOB

Gender

Normal size Small cavity Large cavity Unable to assess

Left ventricular LVIDD (cm) LVIDD (cm) LVIDD (cm)………………..
size ……………… ……………………Indications for study

Normal movement Impaired (more thanDate of study Is there a major regional Unable to assess
Left ventricular
mild) wall motion
function Haemodynamics abnormality?
Right ventricular Normal Small cavity Enlarged Unable to assess
Size Referring Clinician
Normal Impaired RV free wall appears Unable to assess
Right ventricular TAPSE TAPSE (mm) hypertrophied
function (mm)

Inter-atrial septum Mid-systolic reversal Fixed curvature towards the Fixed curvature towards Unable to assess
shape and (normal) right atrium the left atrium
movement
Normal Heavily calcified/restricted Significant AR/valve Unable to assess
AV structure & opening prolapse
function

Normal Heavily calcified/restricted Significant MR/valve Unable to assess

MV structure & opening prolapse
function

Normal Heavily calcified/restricted Significant TR/valve Unable to assess

TV structure & opening prolapse
function

Visually normal size Dilated Unable to assess

Aortic root

Small and/or Normal movement with Large and/or non- Unable to assess
IVC collapsing collapsing
respiration
No pericardial fluid Trivial Significant, +/- signs of Unable to assess
Pericardial fluid seen tamponade

Pleural effusion Yes No

present

Additional
observations

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Conclusion (referenced
to the clinical question)

(training reports are not to

If this a training scan,
be used for patient care
report checked and
unless checked and
approved by:
approved)

(findings reported in red

Does the patient need a
Level 2 study? require immediate expert
help)

Referring physician
informed?

Name and signature

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