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Cardiology · Contributor: Ripot

Echocardiogram report template

A 2D echocardiography reporting structure for chamber measurements, function, valve findings and impression.

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Structure preview · No patient data

2D Echocardiography

Patient: ____________________
Identifier: __________________
Date: ______________________

Report sections

  1. Left Ventricle
  2. Mitral Valve
  3. Left Atrium
  4. Aorta / Aortic Valve
  5. Right Ventricle
  6. Tricuspid Valve
  7. Right Atrium
  8. Inferior Vena Cava (IVC)
  9. Pericardium
  10. Conclusion

Clinician: __________________
Signature: _________________

Included fields

Copy the blank report outline

A reusable starting point, without prefilled normal findings. Complete and check each section for the examination performed.

Patient name: [enter]
Patient identifier: [enter]
Report date: [enter]
Left Ventricle: [enter]
  Chamber Size (cm): [enter]
  End Diastolic Volume (mL): [enter]
  LVIDd (cm): [enter]
  Septal Wall (IVSd) (cm): [enter]
  Posterior Wall (PWDd) (cm): [enter]
  Global Systolic Wall Motion: [enter]
  Ejection Fraction (EF) (%): [enter]
  Regional Wall Motion Abnormality: [enter]
  Diastolic Function: [enter]
  E/A: [enter]
  E/E′: [enter]
  Septal E′ (m/s): [enter]
  Lateral E′ (m/s): [enter]
Mitral Valve: [enter]
  Leaflet Morphology: [enter]
  Mitral Regurgitation: [enter]
  Mitral Stenosis: [enter]
  MR Vmax (m/s): [enter]
  Subvalvular Apparatus: [enter]
Left Atrium: [enter]
  Cavity Size: [enter]
  LA Diameter (cm): [enter]
  LA Area (cm²): [enter]
  Interatrial Septum: [enter]
  Clot / Mass: [enter]
Aorta / Aortic Valve: [enter]
  Aortic Root Diameter (cm): [enter]
  Valve Morphology: [enter]
  AV Vmax (m/s): [enter]
  Peak Gradient (mmHg): [enter]
Right Ventricle: [enter]
  Cavity Dimension (cm): [enter]
  RV Basal Diameter (cm): [enter]
  Systolic Function: [enter]
  TAPSE (cm): [enter]
Tricuspid Valve: [enter]
  Valve Appearance: [enter]
  Leaflet Morphology: [enter]
  Tricuspid Regurgitation: [enter]
  TR Vmax (m/s): [enter]
Right Atrium: [enter]
  Cavity Size: [enter]
  Area (cm²): [enter]
  Clot / Mass: [enter]
Inferior Vena Cava (IVC): [enter]
  IVC Dimension (cm): [enter]
  Inspiratory Collapse: [enter]
  Estimated PAP (mmHg): [enter]
Pericardium: [enter]
  Appearance: [enter]
  Pericardial Effusion: [enter]
Conclusion: [enter]
Impression: [enter]
Signed by: [enter]

Illustrative report layout (fictional)

Not a patient report, verified normal findings, or a PDF exported by Ripot. This is a text-only layout example; always document actual observations.

SAMPLE ONLY · NOT FOR CLINICAL USE

Demonstration echocardiogram report

Indication: Cardiac assessment (fictional)
LV: Enter measured dimensions and systolic function
LVEF: [measured % and method]
RV: Enter measured function and TAPSE
Valves: Describe observed morphology and Doppler findings
Conclusion: Example for layout demonstration, not a clinical result

Clinician: [example] · Signature: [not signed]

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