Get good images

To get a view of the left ventricle at different levels (mitral valve level, papillary muscle level or apical level) it is preferable to slide the transducer apically if possible. Otherwise hold the position and the acoustic window and tilt the transducer.

If the LV is cut oblique and opens up towards the right side of the screen, the transducer is rotated too much clockwise

Remember: The OM should be pointed to the patient’s left side (not towards the left shoulder).

Get good images
If no image can be obtained: if possible, try moving the patient unto his/her left side and place the transducer more laterally.

If the right ventricle is in the center of the image: slide the transducer more laterally to visualise the left ventricle.

These important structures are seen in the apical 4-chamber (AP4CH) view:

These important structures are seen in the parasternal long axis (PLAX) view:

Remember: the OM should be pointed directly towards the right shoulder.

Get good images
Generally: stay close to the border of the sternum.

To

Learning objectives for emergency focused ultrasonography of the heart

To obtain
– a subcostal 4-chamber view (S4C)
– an apical 4-chamber view (A4C)
– a parasternal long axis view (PLAX)
– a parasternal short axis view (PSAX)

To answer focused questions
– Is a pericardial fluid collection present?
– Is the left ventricle systolic function reduced?
– Are signs of pulmonary embolism present?
– Are signs of ascending aortic aneurism/dissection present?

Focused ultrasonography of the heart is best performed withr a cardiac transducer. Alternatively a curved linear/abdominal transducer can be used

The cardiac transducer is a low frequency transducer permitting good penetration.

It has a small footprint that allows visualisation between the ribs.

If looking only for fluid in the pericardium from the subcostal view, an abdominal transducer (also low frequency) can also be used.

The following important structures are seen in the subcostal 4-chamber view: