Facts
When the myocardium contracts it thickens and the lumen of the left ventricle is reduced.

In the image below the myocardium is marked with blue color. The pericardium is the hyperechoic structure just lateral to the myocardium.

The myocardial thickening and the reduction of the lumen is only visible if the myocardium and the endothelial border is visible.

The degree of ventricular lumen reduction caused by myocardial contraction during systole reflects the left ventricular function.

Tips
In order to assess the degree of myocardial thickening and endocardial movement, these structures must be visible and well-defined.

The movement of the pericardium is completely useless for assessing left ventricular function.

Facts
Reduced systolic function and lower stroke volume means less filling of the ventricle in the following diastole.

Lower flow velocities of blood into the left ventricle mean less diastolic opening movement of the mitral valve leaflets (marked with red color in the clip below).

Tips
With normal left ventricular systolic function, the diastolic filling flow causes the anterior mitral valve leaflet tip to come within 1 cm of separation from the septum.

With reduced systolic function that separation increases.

The video below shows examples of pericardial fluid collection obtained in the apical 4-chamber view.

Facts
The left ventricle contracts like wringing out a cloth and the contraction does not only consist of endocardial movement towards the center of the lumen, but also of longitudinal contraction.

Longitudinal contraction is eyeballed by observing the movement of the hyperechoic mitral annulus towards the apex (displayed with green color in the clip below).

Tips
A normal longitudinal function (movements of the mitral annulus >11 mm) generally rules out reduced left ventricular systolic function.

Because of the hyperechogenic structure of the mitral annulus, longitudinal contraction can often be assessed even though image quality is low.

The following important structures are seen in the parasternal short axis (PSAX) view:
Left ventricle
Right ventricle
Right atrium
Tricuspid valve
Septum interventriculare

The following focused questions can be assessed:

Facts
A fluid collection can be seen in in all cardiac views.
Look for a anechoic(black) border around the heart.

Tips
A fluid collection large enough to cause hemodynamic instability will most often also be visible in the subcostal view between the liver and the right side of the heart closest to the transducer.

In emergency cardiac ultrasonography no precise measurements or advanced knobology is needed.

A simple visual qualitative method to evaluate the overall function of the heart and chambers is used.

This method is called eyeballing.

All views can be used for the eyeballing and combined information from different views is recommended.

When eyeballing, always apply suitable humbleness.

Eye-balling for each focused question will be described in further detail.

Tips and tricks
The result of eyeballing the 4 cardiac views below would be: no pericardial effusion, no signs of Type A aortic dissection present, normal left ventricular function, no signs of pulmonary embolism present.

The focused questions in focused ultrasonography of the heart are:

You have now learned how to:

Obtain the following cardiac views, identify the structures and optimise the views for: