Abstract
Cardiac ultrasound, often referred to as echocardiography, is a very broad and technical field. It can take years to master the intricacies; however, with simple training and education of basic heart function and image acquisition, echocardiography can be performed well and accurately by a novice sonographer. Patients young and old can benefit from point-of-care echocardiography to diagnose and ultimately guide treatment, disposition, and further care for their condition. This chapter will introduce the basic skills needed for obtaining standard echocardiographic views that can be used in all fields of medicine. It will review cardiac ultrasound indications, basic anatomy, image acquisition, normal ultrasound anatomy, and interpretation of pathology.
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Parasternal long: Parasternal long cardiac view of a normal heart. Blood flows from the left atrium through the mitral valve, into the left ventricle, and out to the body through the aortic valve. The right ventricle is can be seen at the top of the screen closest to probe face. The descending thoracic aorta is posterior to the heart (MP4 2386 kb)
Parasternal short at the mitral valve: This parasternal short video of a normal heart shows the left in cross section appearing as a circular structure. The mitral valve can be seen opening and closing, depicting the classic “fish mouth” appearance (MP4 1104 kb)
Parasternal short at papillary muscles: When imaging closer to the apex of the heart in a parasternal short view, the papillary muscles will be visualized. Each papillary muscle is usually located at 4 and 8 o’clock within the circular left ventricle (MP4 1094 kb)
Apical four-chamber: Apical four-chamber of a normal heart, with the apex of the heart located at the top of the screen and the base located at the bottom. Ideal orientation is with the septal wall located in vertical orientation, perpendicular to the face of the cardiac transducer. In this view, direct comparison of RV and LV chamber size can be made. It also allows visualization of the septal and lateral LV walls (MP4 1205 kb)
Apical two-chamber: Apical two-chamber cardiac view with the inferior wall of the left ventricle on the left of the screen and anterior wall on the right (MP4 1131 kb)
Subxiphoid: Subxiphoid cardiac ultrasound uses the liver as an acoustic window to image the heart. The RV is most anterior chamber in this view, adjacent to the liver (MP4 1133 kb)
Inferior vena cava: Inferior vena cava is demonstrated in long axis emptying into right atrium (MP4 2411 kb)
Dilated IVC: Dilated, or plethoric, IVC emptying into the right atrium. Note the increased diameter of the IVC and minimal respiratory variation (MP4 2418 kb)
Collapsed IVC: Collapsed IVC emptying into the right atrium. Note the decreased diameter of the IVC and complete collapse of the vessel during inspiration (MP4 2234 kb)
Normal LV systolic function: Normal LV systolic function is characterized by thickening of the left ventricular walls with a decrease in cavity size during systole, anterior leaflet of the mitral valve touching the septum during diastole, and lateral movement of the mitral annulus (MP4 2386 kb)
Mildly reduced left ventricular systolic function: This parasternal long view shows a left ventricle with mildly reduced systolic function. Incidentally noted is a small pericardial effusion (MP4 3607 kb)
Moderately reduced LV systolic function: This parasternal long view shows a hypertrophic left ventricle with moderately reduced, almost severe, systolic function (MP4 1336 kb)
Severely reduced LV systolic function: This parasternal long view shows a dilated left ventricle with severely reduced systolic function. Note minimal change in cavity size, minimal movement of the anterior mitral valve leaflet, and very little lateral movement of the mitral annulus (MP4 2444 kb)
Normal EF with Mitral valve leaflet touching septum: Parasternal long view with anterior leaflet of mitral valve touching the septum during diastole indicating a normal ejection fraction (MP4 2386 kb)
Dilated cardiomyopathy: Parasternal long view demonstrating ballooning of left ventricle typical of dilated cardiomyopathy. Note the left atrium is dilated as well (MP4 3490 kb)
Hypertrophic cardiomyopathy: Parasternal long view demonstrating thickened left ventricular walls typical of hypertrophic cardiomyopathy. Note that systolic function is also reduced (MP4 2386 kb)
Takotsubo cardiomyopathy: This off-axis apical four-chamber view demonstrates isolated apical ballooning as seen in takotsubo cardiomyopathy. Note minimal movement of the apex in systole (MP4 1525 kb)
Hypertrophic obstructive cardiomyopathy: Parasternal long view of severe left ventricular hypertrophy, specifically of the septum. The more hypertrophied anterior septal wall causes obstruction of the outflow tract during systole (MP4 2435 kb)
Parasternal long view of dilated right ventricle: Parasternal long view of a severely dilated right ventricle and associated septal wall bowing into the left ventricle. There is a moderate-sized pericardial effusion as well (MP4 2290 kb)
Parasternal short view of dilated right ventricle: Parasternal short view of an enlarged right ventricle when compared to the left ventricle. This results in septal bowing toward the left ventricle, which causes it to appear “D-shaped” (MP4 1086 kb)
Apical four-chamber RV dilation: Apical four-chamber view demonstrating an RV/LV ratio of greater than 1:1, indicating severe right ventricular dilation (MP4 2296 kb)
Pericardial effusion PSL: Circumferential moderate- to large-sized pericardial effusion visualized on this parasternal long view. Note that the fluid extends anterior to the descending thoracic aorta, differentiating it from pleural effusion (MP4 2434 kb)
Pericardial effusion PSS: Parasternal short view with a moderate- to large-sized pericardial effusion (MP4 2465 kb)
Cardiac tamponade with diastolic collapse of the right atrium: Large pericardial effusion with tamponade causing diastolic collapse of the right atrium, which is most sensitive for cardiac tamponade (MP4 776 kb)
Cardiac tamponade with systolic collapse of the right ventricle: Subxiphoid view of the heart demonstrating a large pericardial effusion causing systolic collapse of the right ventricle, specific for cardiac tamponade (MP4 2351 kb)
Endocarditis: Parasternal long view of endocarditis as visualized by a vegetation on the posterior mitral valve leaflet (MP4 2447 kb)
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Tozer, J., Creditt, A.B., Joyce, M. (2018). Cardiac Ultrasound. In: Clinical Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-319-68634-9_3
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DOI: https://doi.org/10.1007/978-3-319-68634-9_3
Publisher Name: Springer, Cham
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