FoCUS Views
1. Parasternal Window
Image shows the parasternal long and short axis views, obtained from the parasternal window.
A. Parasternal Long Axis
Probe: Cardiac/Phased Array
Position: Left Lateral Decubitus
Protocol: 2nd to 4th intercostal space; left parasternal. Transducer marker faces patients right shoulder
Picture: Set depth to 16-20cm to obtain a PLAX scout view. Reduce depth so that heart occupies most of the display. Descending thoracic aorta is seen in the far field. Mitral & aortic valve are in the centre of the display. The LV apex should not be seen.
Can you name the structures A-G?
B. Parasternal Short Axis
Parasternal Short Axis: Aortic Level. The probe is angled cephalad with clockwise rotation. Can you identify the aortic valve, tricusoid and pulmonary valves? Locate the RA, RV and Pulmonary Trunk.
Parasternal Short Axis: Mitral Valve (Basal) Level. The mitral valve orrifice is seen in this view. The basal segments of the LV wall can be evaluated. Can you identify any pathology ?
Parasternal Short Axis: Mid-Papillary Level. Can you identify the following?
- Anterior, inferior, septal and lateral walls
- Papillary muscles
- Right ventricle
Probe: Cardiac/Phased Array
Position: Left Lateral Decubitus
Protocol: 2nd to 4th intercostal space; left parasternal. Transducer marker faces patients left shoulder
Picture: The parasternal short axis can be divided into 4 levels. These are:
- Aortic Valve Level
- Mitral Valve Level (Basal)
- Mid-Papillary
- Apical
2. Apical Window
Image shows the apical window and the associated views that can be obtained. Note the counterclockwise probe rotation used to obtain the apical views, starting at the apical 4 chamber and ending at the apical 2 chamber.
A. Apical 4 Chamber
This is an apical 4 chamber view. Can you identify all 4 cardiac chambers, the anterior lateral LV wall, septal LV wall and RV free wall?
B. Apical 5 Chamber
This is an apical 5 chamber view. From the 4 chamber view, angulate the probe cephalad. Can you identify the LVOT and aortic valve?
C. Apical 2 Chamber
This is an apical 2 chamber view. Can you identify the anterior and inferior LV walls?
D. Apical 3 Chamber
This is an apical 3 chamber view. Can you identify the mitral valve, aortic valve and LVOT? The LV and LA are also visible in this view. Can you identify them?
E. RV Focused View
This is an apical 4 chamber RV focused view. The right ventricle is completely visible. This view should be used for quatitative evaluation fo the RV. What 3 RV features can help you to differentiate it from the LV on echo?
The apical views are obtained by placing the probe at the point of maximal impulse (apex) of the heart. The transducer marker should face the patient’s left flank. We can obtain 5 views here – Apical 4 Chamber, 5 Chamber, 3 Chamber & 2 Chamber views. The final view is the RV focused view.
- The 4 chamber view is obtained first.
- Angulate the probe head cephalad (tail inferiorly) to obtain the A5C view.
- Rotate counterclockwise to obtain the A2C view
- Rotate further counterclockwise to obtain the A3C view.
- The RV focused view is obtained by sliding the probe to the left over the chest wall from the A4C view, to bring the RV into the centre of the display.
3. Subcostal Window
A. Subcostal 4 Chamber
The subcostal 4 chamber view is seen above. Can you identify the 4 cardiac chambers, the mitral and tricuspid valves?
B. Subcostal IVC
The inferior vena cava is seen here, in the subcostal IVC view. How can you differentiate between the IVC and abdominal aorta? Where should you measure the IVC diameter?
C. Subcostal Abdominal Aorta
What structure is seen here? Is it the IVC or abdominal aorta? How do you differentiate the 2?
The subsotal views are best obtained with the patient semi-recumbent with knees flexed. This allows for relaxation of the abdominal muscles and is more comfortable for the patient.
The subcostal 4 chamber and subcostal IVC views are obtained in this position.
