<p><strong>&nbsp; &nbsp; &nbsp; &nbsp;</strong></p><figure class="table"><table><tbody><tr><td><strong>HEIGHT(cm) =</strong></td><td><strong>WEIGHT(Kg) =</strong></td><td><strong>BSA =</strong></td></tr></tbody></table></figure><figure class="table"><table><tbody><tr><td><strong>Clinical Information:</strong>&nbsp;</td></tr></tbody></table></figure><p><strong>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;M - MODE</strong></p><figure class="table"><table><tbody><tr><td>Aortic room [mm]=<br>Asc Aorta [mm]=</td><td><p>IVSTd [mm]=</p><p>IVSTs [mm]=</p></td><td><p>LVEF [%]=</p><p>LVSF [%]=</p></td></tr><tr><td><p>AVD [mm]=</p><p>LA [mm]=</p></td><td>LVPWTd [mm]=<br>LVPWTs [mm]=</td><td><p>LV mass [g]=</p><p>LV Mass Index=</p></td></tr><tr><td><p>RV basal [mm]=</p><p>TAPSE (mm) =&nbsp;</p></td><td><p>LVEDD [mm]=</p><p>LVESD [mm]=</p></td><td>&nbsp;</td></tr></tbody></table></figure><p><strong>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;DOPPLER</strong></p><figure class="table"><table><tbody><tr><td colspan="4">&nbsp;</td></tr><tr><td rowspan="2"><strong>Aortic Valve:</strong></td><td>&nbsp;Peak Vel [m/s] = &nbsp;</td><td>&nbsp; Mean Pressure Gradient [mmHg] =&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</td><td rowspan="2">AV regurgitation =</td></tr><tr><td>VTI (cm) =</td><td>LVET [ms] =</td></tr><tr><td colspan="4">&nbsp;</td></tr><tr><td rowspan="2"><strong>Mitral Valve:</strong></td><td>E wave Vel [cm/s] =</td><td>A wave Vel [cm/s] =&nbsp;</td><td rowspan="2">MV regurgitation =</td></tr><tr><td>e"Vel [cm/s] = &nbsp;</td><td>a"Vel [cm/s] =&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</td></tr><tr><td colspan="4">&nbsp;</td></tr><tr><td><strong>Tricuspid Valve:</strong></td><td>TR peak Vel [m/s] =</td><td colspan="2">&nbsp; TV regurgitation =&nbsp;</td></tr><tr><td colspan="4">&nbsp;</td></tr><tr><td rowspan="2"><p><strong>Pulmonary Valve:</strong></p><p>&nbsp;</p></td><td>Peak Vel [m/s] =</td><td>Acceleration Time [m/s] =&nbsp;</td><td>PV regurgitaion = &nbsp; &nbsp;</td></tr><tr><td>&nbsp;PA systolic pressure [mmHg] =&nbsp;</td><td>&nbsp;MPAP [mmHg] =&nbsp;</td><td>&nbsp;<strong>Pulmonary HTN = &nbsp;&nbsp;</strong></td></tr></tbody></table></figure><p><strong>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;2-D Morphology</strong></p><figure class="table"><table><tbody><tr><td>AORTIC ROOT:&nbsp;</td></tr><tr><td>LEFT VENTRICLE:</td></tr><tr><td>OTHER CHAMBERS:</td></tr><tr><td>VALVES:</td></tr><tr><td>PERICARDIUM:</td></tr></tbody></table></figure><p><strong>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;COMMENTS</strong></p><figure class="table"><table><tbody><tr><td><p>&nbsp;</p><p>&nbsp;</p><p>&nbsp;</p></td></tr></tbody></table></figure><p>_________________________________________________________________________________________________________________________</p><p><i><strong>ECHOCARDIOGRAPHY PERFORMED BY:</strong></i> <strong>Dr. Bashir G Ahmad MBBS, FWACP (Int. Med - Cardiol.)</strong></p><p><i><strong>DATE:___________________________________ &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;SIGNATURE:</strong></i><strong>_______________________________________</strong></p>