Here the ACES protocol aims to identify gross abnormalities of cardiac function and size. The subjective visual assessment of global systolic function correlates with more formal quantitative measurements of left ventricular ejection fraction, 9 and emergency physicians with limited training show high interobserver agreement with cardiology specialists. 10 11 A hypodynamic left ventricle in a hypotensive patient generally suggests a cardiogenic cause. Pleural effusions associated with cardiac failure may be seen on the right or left upper quadrant views.