Pocket-Size Hand-Held Echocardiography

  • Vasileios F. Panoulas
  • Petros NihoyannopoulosEmail author


Pocket-size hand-held echocardiography (PHE) devices have recently emerged as a new category of miniaturized echo machines. They are relatively cheap, smartphone-size hand-held echo machines with limited technical capabilities. They aim to improve upon physician diagnostic skills rather than provide a tool for a comprehensive diagnostic echocardiographic examination. They are often used in both emergency and outpatient clinic settings, leading physicians to correct differential diagnoses and treatment pathways. With the exception of cardiologists who are certified for transthoracic echocardiography according to national legislation, specific training and certification is recommended by European and American guidelines for all other users, to avoid misuse and misinterpretation of the findings of PHE. The length and the duration of training, however, remains a matter of debate. In the current chapter we discuss the history, technical characteristics and use of PHE with examples taken from real-life scenarios.


Pocket size Hand held Echocardiography Miniaturisation 2D Colour doppler Device 

Supplementary material

Video 39.1

Parasternal long axis of a patient with dilated cardiomyopathy and severe mitral regurgitation (MP4 133 kb)

Video 39.2

Subcostal views of a patient who presented with haemodynamic compromise, showing large pericardial effusion causing right ventricular compression (tamponade) (MP4 267 kb)

Video 39.3

Patient presenting with anterior ST elevation myocardial infarction. V-scan parasternal long axis revealed extensive anteroseptal, akinesia, consistent with acute thrombotic occlusion of the left anterior descending (MP4 300 kb)

Video 39.4

Four chamber view of the same patient with anterior ST elevation myocardial infarction reveals apical and mid to apical lateral akinesia (MP4 159 kb)

Video 39.5

V-scan of a patient presenting with pulmonary oedema. Parasternal long axis reveals heavily calcified aortic cusps with restricted mobility, findings consistent with severe aortic stenosis (MP4 198 kb)

Video 39.6

Normal V-scan echocardiography in a young lady with atypical symptoms (parasternal long axis) (MP4 238 kb)

Video 39.7

V-scan: parasternal long axis revealing asymmetric septal hypertrophy in a young athlete with deep lateral T wave inversions on screening ECG. Patient was diagnosed with hypertrophic cardiomyopathy (MP4 229 kb)


  1. 1.
    Roelandt JR. Seeing the heart; the success story of cardiac imaging. Eur Heart J. 2000;21(16):1281–8.CrossRefGoogle Scholar
  2. 2.
    Senior R, Galasko G, Hickman M, Jeetley P, Lahiri A. Community screening for left ventricular hypertrophy in patients with hypertension using hand-held echocardiography. J Am Soc Echocardiogr. 2004;17(1):56–61.CrossRefGoogle Scholar
  3. 3.
    Fukuda S, Shimada K, Kawasaki T, Fujimoto H, Maeda K, Inanami H, et al. Pocket-sized transthoracic echocardiography device for the measurement of cardiac chamber size and function. Circ J. 2009;73(6):1092–6.CrossRefGoogle Scholar
  4. 4.
    Liebo MJ, Israel RL, Lillie EO, Smith MR, Rubenson DS, Topol EJ. Is pocket mobile echocardiography the next-generation stethoscope? A cross-sectional comparison of rapidly acquired images with standard transthoracic echocardiography. Ann Intern Med. 2011;155(1):33–8.CrossRefGoogle Scholar
  5. 5.
    Galderisi M, Santoro A, Versiero M, Lomoriello VS, Esposito R, Raia R, et al. Improved cardiovascular diagnostic accuracy by pocket size imaging device in non-cardiologic outpatients: the NaUSiCa (Naples ultrasound stethoscope in cardiology) study. Cardiovasc Ultrasound. 2010;8:51.CrossRefGoogle Scholar
  6. 6.
    Biais M, Carrie C, Delaunay F, Morel N, Revel P, Janvier G. Evaluation of a new pocket echoscopic device for focused cardiac ultrasonography in an emergency setting. Crit Care. 2012;16(3):R82.CrossRefGoogle Scholar
  7. 7.
    Prinz C, Voigt JU. Diagnostic accuracy of a hand-held ultrasound scanner in routine patients referred for echocardiography. J Am Soc Echocardiogr. 2011;24(2):111–6.CrossRefGoogle Scholar
  8. 8.
    Panoulas VF, Daigeler AL, Malaweera AS, Lota AS, Baskaran D, Rahman S, et al. Pocket-size hand-held cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors. Eur Heart J Cardiovasc Imaging. 2013;14(4):323–30.CrossRefGoogle Scholar
  9. 9.
    Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2013;26(6):567–81.CrossRefGoogle Scholar
  10. 10.
    Spencer KT. Focused cardiac ultrasound: where do we stand? Curr Cardiol Rep. 2015;17(3):567.CrossRefGoogle Scholar
  11. 11.
    Coletta C, De Marchis E, Lenoli M, Rosato S, Renzi M, Sestili A, et al. Reliability of cardiac dimensions and valvular regurgitation assessment by sonographers using hand-carried ultrasound devices. Eur J Echocardiogr. 2006;7(4):275–83.CrossRefGoogle Scholar
  12. 12.
    Giannotti G, Mondillo S, Galderisi M, Barbati R, Zaca V, Ballo P, et al. Hand-held echocardiography: added value in clinical cardiological assessment. Cardiovasc Ultrasound. 2005;3:7.CrossRefGoogle Scholar
  13. 13.
    Brennan JM, Blair JE, Goonewardena S, Ronan A, Shah D, Vasaiwala S, et al. A comparison by medicine residents of physical examination versus hand-carried ultrasound for estimation of right atrial pressure. Am J Cardiol. 2007;99(11):1614–6.CrossRefGoogle Scholar
  14. 14.
    Weiner RB, Wang F, Hutter AM Jr, Wood MJ, Berkstresser B, McClanahan C, et al. The feasibility, diagnostic yield, and learning curve of portable echocardiography for out-of-hospital cardiovascular disease screening. J Am Soc Echocardiogr. 2012;25(5):568–75.CrossRefGoogle Scholar
  15. 15.
    Wyman RA, Chiu RY, Rahko PS. The 5-minute screening echocardiogram for athletes. J Am Soc Echocardiogr. 2008;21(7):786–8.CrossRefGoogle Scholar
  16. 16.
    Choi BG, Mukherjee M, Dala P, Young HA, Tracy CM, Katz RJ, et al. Interpretation of remotely downloaded pocket-size cardiac ultrasound images on a web-enabled smartphone: validation against workstation evaluation. J Am Soc Echocardiogr. 2011;24(12):1325–30.CrossRefGoogle Scholar
  17. 17.
    Singh S, Bansal M, Maheshwari P, Adams D, Sengupta SP, Price R, et al. American Society of Echocardiography: remote echocardiography with web-based assessments for referrals at a distance (ASE-REWARD) study. J Am Soc Echocardiogr. 2013;26(3):221–33.CrossRefGoogle Scholar
  18. 18.
    Beaton A, Okello E, Lwabi P, Mondo C, McCarter R, Sable C. Echocardiography screening for rheumatic heart disease in Ugandan schoolchildren. Circulation. 2012;125(25):3127–32.CrossRefGoogle Scholar
  19. 19.
    Kobal SL, Lee SS, Willner R, Aguilar Vargas FE, Luo H, Watanabe C, et al. Hand-carried cardiac ultrasound enhances healthcare delivery in developing countries. Am J Cardiol. 2004;94(4):539–41.CrossRefGoogle Scholar
  20. 20.
    Zamorano JL, Moreno R, Alburquerque C. Echocardiography performed by physicians outside of echo-labs - is it possible? Eur Heart J. 2002;23(11):908–9.CrossRefGoogle Scholar
  21. 21.
    Popescu BA, Andrade MJ, Badano LP, Fox KF, Flachskampf FA, Lancellotti P, et al. European Association of Echocardiography recommendations for training, competence, and quality improvement in echocardiography. Eur J Echocardiogr. 2009;10(8):893–905.CrossRefGoogle Scholar
  22. 22.
    Nihoyannopoulos P, Fox K, Fraser A, Pinto F, Laboratory Accreditation Committee of the EAE. EAE laboratory standards and accreditation. Eur J Echocardiogr. 2007;8(1):80–7.CrossRefGoogle Scholar
  23. 23.
    Sicari R, Galderisi M, Voigt JU, Habib G, Zamorano JL, Lancellotti P, et al. The use of pocket-size imaging devices: a position statement of the European Association of Echocardiography. Eur J Echocardiogr. 2011;12(2):85–7.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Vasileios F. Panoulas
    • 1
  • Petros Nihoyannopoulos
    • 2
    Email author
  1. 1.Department of CardiologyRoyal Brompton and Harefield NHS Foundation TrustLondonUK
  2. 2.Imperial College London, Hammersmith HospitalLondonUK

Personalised recommendations