There is no universally accepted imaging protocol for point-of-care cardiac ultrasound. Image acquisition and interpretation skills of the examiner are crucial in order to diagnose common conditions and comprehend the limitations of the approach . Certain imaging views are easier to obtain (such as parasternal and subcostal views), others need more expertise (such as apical views), and certain techniques require comprehensive training (such as color and spectral Doppler) . The following abnormalities can be accurately detected using point of care cardiac ultrasound: left ventricular enlargement, hypertrophy, and systolic dysfunction; right ventricular enlargement and dysfunction; pericardial effusion; and elevated central venous pressure . Correct quantification of the detected abnormalities requires comprehensive echocardiography. The current chapter (Figs. 16.1, 16.2, 16.3, 16.4, 16.5, 16.6, 16.7, 16.8, 16.9, 16.10, 16.11, 16.12, 16.13, and 16.14; Videos 16.1, 16.2, 16.3, 16.4, 16.5, 16.6, 16.7, and 16.8; and Table 16.1) reviews some common views that can be obtained and interpreted during point of care ultrasound examination.
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Parasternal long axis view. This view allows visualization of the right ventricular outflow tract (RVOT), left atrium (LA) and left ventricle (LV). The interventricular septum (IS) and the inferolateral wall (ILW) of the left ventricle are also seen. Bright pericardium (Per) is seen behind the left ventricle. This view also allows identification of the aortic valve (Ao) and aortic root (Ar), anterior (AL) and posterior (PL) leaflets of the mitral valve, and descending aorta (DA). Color Doppler examination in this view allows visualization of mitral regurgitation and aortic regurgitation. See also Fig. 16.2 (AVI 9711 kb)
Video 16.2Parasternal long axis view in a patient with shortness of breath. The left ventricle (LV) is dilated and left ventricular ejection fraction is reduced. Parasternal views allow approximate assessment of the left ventricular size and identification of significant left ventricular systolic dysfunction. Sea also Fig. 16.3 (AVI 8822 kb)
Video 16.3Parasternal short axis view at the level of the papillary muscles. Left ventricle (LV), interventricular septum (IS) and right ventricle (RV) are seen. The left ventricle appears round and symmetric. Anterolateral (AL) and posteromedial (PM) papillary muscles are the landmarks at this level. This view is useful for rough assessment of the left ventricular systolic function. See also Fig. 16.6 (AVI 2524 kb)
The parasternal short axis view in a patient with shortness of breath. The right ventricle (RV) is dilated while the left ventricle (LV) appears smalls and hyperdynamic. The interventricular septum (IS) is flattened making the left ventricle D-shaped instead of the normal round shape. Pericardial effusion (PEF) is also seen. This patient has pulmonary hypertension with right ventricular failure. See also Fig. 16.7 (AVI 14717 kb)
Video 16.5Apical four-chamber view. The left ventricle (LV), right ventricle (RV), interventricular septum (IS) and the anterolateral wall (AL) of the left ventricle, left atrium (LA), right atrium (RA) and interatrial septum (IAS) are seen. Adequate visualization of the apex is essential for correct estimation of the left ventricular ejection fraction. Apical foreshortening may result in overestimation of the ejection fraction. See also Fig. 16.9 (AVI 2684 kb)
Video 16.6Subcostal four-chamber view. The liver (Lr) and the bright line of diaphragm (Da) are seen. The right heart, including right ventricle (RV) and right atrium (RA) are closer to the transducer in this view, while the left ventricle (LV) and left atrium (LA) are in the far field. See also Fig. 16.11 (AVI 2209 kb)
Video 16.7Subcostal view in a patient with shortness of breath. The pericardial effusion (PEF) is seen as an echo-free space around the heart, most prominent over the diaphragm underlying the right ventricle (RV) and right atrium (RA). Also, systolic function of the left ventricle (LV) is reduced. This patient has systolic heart failure and pericardial effusion. See also Fig. 16.12 (AVI 2435 kb)
Inferior vena cava assessment. The inferior vena cava (IVC) is seen in the subcostal view. The diameter of the inferior vena cava and collapsibility with respiration (or a brief sniff) should be noted. See also Fig. 16.13 (AVI 3062 kb)
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