FCU typically involves qualitative imaging of the heart with 2D ultrasound. Other modalities such as color doppler and M-mode can be used to provide further semi-quantitative and quantitative information.
Doppler evaluation of blood flow velocities is typically not used in FCU, however this depends on the experience of the operator. Additionally, most hand held probes used in POCUS do not have doppler capabilities.
This is however changing rapidly with developments in technology. Doppler is useful for quantitative evaluation of stroke volume and cardiac output, interrogation of valvular function and assessment of diastolic function. These are often performed as part of a critical care echocardiography study.
Figure showing the 2D and color doppler methods of assessment used in basic critical care echo (CCE) / Focused Cardiac Ultrasound (FCU) on the left in comparison to doppler evaluation used in advanced CCE. Image from: A decade of progress in critical care echocardiography: a narrative review. Vieillard-Baron et al. Intensive Care Medicine, 2019. Website or PDF.
Windows
3 echo windows are used in FCU These are the left parasternal, apical and subcostal windows. Image From: Seif et al. Critical Care Research and Practice, 2012. Website or PDF
Left Parasternal (A)
Apical (C)
Subcostal / Sub Xiphoid (B)
Imaging Planes
Cardiac Ultrasound Scanning Planes – 3 scaning planes are used. These are the apical, short axis and long axis planes. Image from: Mitchell et al. JASE 2018. Website or PDF
5 Views
Parasternal Long Axis
Parasternal Short Axis
Apical 4 Chamber
Subcostal 4 Chamber
Subcostal Inferior Vena Cava
Settings
Use cardiac preset.
Adjust gain until blood appears black.
PLAX Scout View: Adjust depth to 16 – 20 cm to obtain a deep image which allows for the pleural space and descending aorta to be seen. Pathology here can be missed if the depth is not adjusted appropriately.
Subsequently, you can adjust the depth accordingly to include the area of interest in each of the FCU views.
Use probe manipulations to optimize image:
- Tilt
- Sweep
- Rotate
- Slide
- Rock
- Angle
Image showing the tilting maneuver. Image from: Mitchell et al. JASE 2019.
Image showing the sliding maneuver. Image from: Mitchell et al. JASE 2019.
Image showing the rocking maneuver. Image from: Mitchell et al. JASE 2019
Probe Manipulations were discussed in detail in the Basic Ultrasound Physics Course. Here is a video recap in case you missed it.