Basic cardiac views include the parasternal long axis, parasternal short axis, and apical four-chamber (with additional apical five-chamber) views. These allow for a gross assessment of valvular structures and left ventricular function.
Parasternal Long
Parasternal Short
Parasternal Short
Parasternal Short
Parasternal Short
Parasternal Short
Apical 4 Chamber
Parasternal Short
Apical 4 Chamber
Parasternal long axis (PSL)
Point the probe indicator toward the patient’s right shoulder
Place the probe at the 4th intercostal space which is around the nipple line in males or the inframammary fold to the sternum in females
Center image on screen, heel/rock if needed.
Rotate to lengthen the left ventricular outflow tract (LVOT)
Sweep/fan to widen the LV
Parasternal Short (PSS)
From the PSL, rotate your probe 90 degrees clockwise so the indicator is pointing towards the patient’s left shoulder
Visualize the following 3 levels:
Mid-papillary level
Mitral valve level (Fish mouth view, showing the anterior and posterior leaflets)
Aortic valve level (Mercedes Benz view, tilt the tail of the probe inferiorly and point it towards the aortic Valve)
Apical 4 Chamber (A4C)
From PSS, slide towards apex of the heart with the indicator pointed towards the patient’s left side. You can recognize the apex by observing the LV decrease in size
As you do this, A4C view should appear. If you are having trouble with the A4C view, reposition the patient in the left lateral decubitus position. It reduces lung artifact and brings the heart closer to the ultrasound probe, usually giving a better view.
Heel/rock to make septum vertical.
Sweep/fan to easily see all four chambers.
Rotate to widen the ventricles.
Note: From A4C, fan towards the patient’s feet to get the A5C. This allows visualziation of the aortic valve and the LVOT.
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