Cardiac ultrasound

Background

• Use phased array probe
• Important to realize that the cardiac ultrasound preset on some machines reverses the indicator marking with the probe indicator on the right. With the general ED ultrasound the probe indicator is on the left of the screen.

Technique

Parasternal Long

• Pointer to the L hip, probe at L 3rd/4th intercostal space adjacent to sternum
• Use to visualize global function and r/o pericardial effusion/tamponade
  • Can evaluate mitral valve, aortic valve, aortic root, LV squeeze

Parasternal Short

• Pointer to L shoulder, probe at L 3rd/4th intercostal space adjacent to sternum
• Tip: obtain parasternal long view, then rotate probe 90 degrees
• Use to evaluate LV squeeze, R ventricle
  • R heart strain = dilated R ventricle

Apical 4 chamber

• Pointer to Right, usually below nipple
• Use to visualize global function (Left and right ventricle, squeeze)

Subxyphoid

• Pointer to Right, subxyphoid with probe pointed toward head
• Use liver to as acoustic window to visualize heart

Suprasternal

• Pointer at 12 o'clock (cephalad) and place in sternal notch
• Move probe inferior and to the left to visualize aortic arch
• Rotate probe clockwise for further image optimization
  • Can evaluate for aortic dissections/aneurysms and aortic stenosis/regurg.

Measurements

Aorta

• Normal aortic root is <3.8 cm (parasternal view w/ dot pointing to Lt arm)

Classic Ultrasound Findings For Critically Ill Patients

Disease	Cardiac	IVC	Lung (Phased Array)	Lung (Linear)
MI	Focal WMA Mod/Poor squeeze	↑	NL or B-lines	Sliding
Tamponade	RA collapse with filling RV collapse with filling	↑	NL	Sliding
PTX	NL or Hyperdynamic	↑	Lung point Consolidated lung	Absent lung sliding
Sepsis	Hyperdynamic squeeze	↓	NL (see pneumonia)	Sliding
Pneumonia	Hyperdynamic squeeze	NL or ↓	Unilateral B-lines	Sliding
Decompensated HF	Mod/Poor squeeze	↑	Bilateral B-lines	Sliding
PE	RV > LV McConnell's sign	↑	NL or Unilateral B-lines	Sliding

Pericardial Effusion

• For cardiac tamponade, look for bowing of RA or RV wall inward during diastole
• Can be used to identify pocket of fluid for pericardiocentesis

See Also

• Ultrasound (Main)
• Pericardial Effusion and Tamponade

Source

Sonosite Uptodate