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Cardiac US

THE VIEWS

BASIC ECHO VIEWS

In any examination try and look at the heart from as many views as possible. This allows you to form a 3D construction from multiple 2D images. This is especially important if you see any pathology. When making a diagnosis, try and confirm the presence of pathology in at least 2 views. 

Echo is typically performed with the patient in the left lateral position with the left arm raised above the head. This moves the heart closer to the chest wall and decreases artefact created by the lungs. However, the time when you will need echo the most is in the arrested patient who cannot be manoeuvered into an optimal position for echo. Therefore always practise in the supine patient and only reposition if you have real difficulty finding a good window. 

For an in depth explanation on performing an echo see the ASE guideline on how to perform an echo (1).

Make big movements initially to find the best window 

For each of the views, begin in the typical place on the patient's chest described below, then make big movements until you find the heart in an intercostal space (window). Once you find the heart, anchor your hand on the chest at this spot with the fingers not holding the transducer. Following this make small rotational, fanning and rocking movements until the image on the screen is as close to the ideal image (on axis) for that view as possible. If you cannot get an on axis images in this window, move to another intercostal space and try again. 

The image depth should be set so that the heart fills the screen. The gain should be set so that the cardiac cavity is anechoic (black).

The four main echo views are

  • Parasternal Long axis (PLAx)
  • Parasternal Short axis (PSAx)
  • Apical four chamber (A4C)
  • Subxyphoid (including IVC)

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How to Scan the Heart

REFERENCES

1. Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, Horton K, Ogunyankin KO, Palma RA, Velazquez EJ. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019 Jan;32(1):1-64.