Blood Supply (all views)

Labeled

The anterior wall

The inferior-medial wall

The LV as a supplement to the 4 chamber and

long axis views
Quick
Wall thickness

Chamber dimensions
Apical 2-Ch
What good for
Valve function together with the apical 4
chamber and long axis views

Mitra! inflow and diastolic function

MR / MS

Comprehensive
Regional quantitative LV function

Global quantitative left ventricle function in

conjunction with other cardiac views
Labeled

Pathology

SC 4-Ch Wall thickness

Labeled What can be assessed
Chamber dimensions
The anterior-medial wall (anterior part of the
interventricular septum) Bi-ventricular function

The inferior-lateral wall

The LV supplementary to the 4 chamber and 2

chamber views
Quick Labelled

Wall thickness
The subcostal IVC view is obtained by placing
the transducer in the subcostal position,
Chamber dimensions slightly to the right of the mid line
How to obtain
Apical LAX
Valve function together with the apical 4 What good for The orientation marker on the transducer
chamber and 2 chamber views should be directed cranially

MitraI inflow and diastolic function IVC dimension

Cardiac output in the LVOT IVC dynamics with respiration

What can be assessed

Regional quantitative left ventricular function Placement of umbilical catheter in neonates

Comprehensive

Global quantitative left ventricle function in IVC dynamics for the optimization of fluid responsiveness
conjunction with other cardiac views
IVC IVC diameter (1-3cm from atrial junction)
MS / MR / AS / AR How is it assessed?
Collapsibility

IVC diameter <2.1 cm and >50% collapse

(inspiratory sniff) suggests normal RA
pressure (0-5 mm Hg)

Labeled IVC diameter >2.1 cm and <50% collapse

Volume responsiveness
RA P° (inspiratory sniff) suggests high RA pressure
(1 0-20 mmHg)
Left ventricular outflow tract How is it interpreted?
IVC diameter and collapse that do no.t fit in to
Aortic valve these two scenarios indicate intermediate RA
pressure increase (5-10 mm Hg)

Ascending aorta (proximal part)

Quick
Wall thickness Volume Responsiveness

Chamber dimensions

Apical 5-Ch
Global myocardial function in conjunction with
other cardiac views What good for

Blood flow in the LVOT Apical 4-Ch Labeled

Cardiac output in the LV outflow tract What good for: Same as S4Ch

Regional quantitative left ventricular function

Comprehensive

Global quantitative left ventricular function in

conjunction with other cardiac views
Labeled

MS / MR / AS / AR
Pathology

Wall thickness (M-mode)

PLAX
What good for Chamber dimensions (M-mode)

Labeled Mitra! septa! separation (M-mode)

←ADVANCED
Papillary muscle rupture Parasternal SAX (Mitral)
Aortic and mitral valves
What good for
MV vegetations FATE
BASIC→

Labeled

Pathology
Labeled
Parasternal SAX (Aortic)
Dimensions of cavities: Left and right ventricle
Central PE What good for
PSAX
Myocardium: Left and right ventricle
What good for

Global

Left ventricular function:

Regional (Myocardium with blood supply from
all three coronary arteries represented)
↔
Labeled

The ascending aorta

The aortic arch

Suprasternal
The proximal part of the descending aorta Labeled (L R)

What good for

Vessels to the neck Pleural effusion

Aortic valve stenosis and insufficiency with Pleural Atelectasis/lung parenchyma

Doppler

What good for Pneumothorax

Aortic dissection

Pulmonary edema
Done by selecting "Simpson's Biplane", then
tracing diastolic images of the atrium and
ventricle on the A4Ch and A2Ch Correct intubation confirmed by bi-lateral lung sliding
Modified Simpsons Biplane

Used for LV / RV volume estimation

EF (eyeballing)

FS

Views: A5Ch / ALAX (CWD)

Aortic P° gradient

Used for AR / AS → P° gradient is measured MSS (Normally < 1cm)

and peak velocity → should be > 3 m/s
Measures of LV function on PLAX

End stage P° gradient may not indicate

severity due to LV failure ∴ always Other considerations
assess LV function in conjunction with LA Dimension
Calculations
P° drop

What view: A4Ch (CWD)

Used for MR / MS

MAPSE (Normally > 11mm)

Atrial P° has to be added → convert to EF using FATE card
to the estimated P° drop
What other considerations
Tricuspid P° gradient
Easy to misinterpret trivial MR as severe AS

Premises

TAPSE (Normally > 16-20mm)

→ convert to EF using FATE card
CSA is taken from the diameter
just under the Aortic cusps (inner CSA
edge to inner edge) in mid systole

PLAX or Apical LAX Calculations

Views Cardiac Output

Pathologies

VTI using PWD (Apical 5-Ch) Dont forget POC lung ultrasound (not
FATE) - B-lines, sand on the beach, etc
CO = VTI x HR x CSA

E = Transmitral PWD early filling

A = Transmitral PWD atrial contraction Normal

E/A (Transmitral PWD)

Abnormalities

S = systolic velocity, normal value around 5m/s

with the myocardium moving towards the
transducer
Diastolic function
E' = Mitra! annulus TDI early filling

A' = Mitra! annulus TDI atrial contraction Normal

Tissue Doppler (A4Ch)

Normally < 8 for TDI measured at the
interventricular septum

Normally < 10 for TDI measured in the lateral

wall
Abnormalities
/ ←ADVANCED / SC 4-Ch
/ ←ADVANCED / SC 4-Ch / Labeled
/ ←ADVANCED / IVC
/ ←ADVANCED / IVC / Labelled
/ ←ADVANCED / IVC / Volume responsiveness / How is it interpreted? / Volume Responsiveness
/ ←ADVANCED / Apical 4-Ch
/ ←ADVANCED / Apical 4-Ch / Labeled
/ ←ADVANCED / PLAX
/ ←ADVANCED / PLAX / Labeled
/ ←ADVANCED / PSAX
/ ←ADVANCED / PSAX / Labeled
/ ←ADVANCED / Pleural
/ ←ADVANCED / Pleural / Labeled (L ↔ R)
/ ←ADVANCED / Calculations / EF (eyeballing)
/ ←ADVANCED / Calculations / Measures of LV function on PLAX
/ ←ADVANCED / Calculations / Measures of LV function on PLAX / FS
/ ←ADVANCED / Calculations / Measures of LV function on PLAX / FS
/ ←ADVANCED / Calculations / Measures of LV function on PLAX / MSS (Normally < 1cm)
/ ←ADVANCED / Calculations / Measures of LV function on PLAX / LA Dimension
/ ←ADVANCED / Calculations / MAPSE (Normally > 11mm)
/ ←ADVANCED / Calculations / TAPSE (Normally > 16-20mm)
/ ←ADVANCED / Pathologies
/ ←ADVANCED / Calculations / Aortic P° gradient / Views: A5Ch / ALAX (CWD)
/ ←ADVANCED / Calculations / Tricuspid P° gradient
/ ←ADVANCED / Calculations / Cardiac Output / Views / CSA / PLAX or Apical LAX
/ ←ADVANCED / Calculations / Cardiac Output / Views / VTI using PWD (Apical 5-Ch)
/ ←ADVANCED / Calculations / Diastolic function
/ ←ADVANCED / Calculations / Diastolic function / E/A (Transmitral PWD)
/ ←ADVANCED / Calculations / Diastolic function / E/A (Transmitral PWD) / Normal
/ ←ADVANCED / Calculations / Diastolic function / E/A (Transmitral PWD) / Abnormalities
/ ←ADVANCED / Calculations / Diastolic function / Tissue Doppler (A4Ch)
/ ←ADVANCED / Calculations / Diastolic function / Tissue Doppler (A4Ch) / Normal
/ ←ADVANCED / Calculations / Diastolic function / Tissue Doppler (A4Ch) / Abnormalities
/ ←ADVANCED / Suprasternal
/ ←ADVANCED / Suprasternal / Labeled
/ ←ADVANCED / Parasternal SAX (Aortic)
/ ←ADVANCED / Parasternal SAX (Aortic) / Labeled
/ ←ADVANCED / Parasternal SAX (Mitral)
/ ←ADVANCED / Parasternal SAX (Mitral) / Labeled
/ ←ADVANCED / Apical 5-Ch
/ ←ADVANCED / Apical 5-Ch / Labeled
/ ←ADVANCED / Apical LAX
/ ←ADVANCED / Apical LAX / Labeled
/ ←ADVANCED / Apical 2-Ch
/ ←ADVANCED / Apical 2-Ch / Labeled
/ ←ADVANCED / Blood Supply (all views)