Category Archives: Cardiac

Common PAtterns seen 1. LV Systolic Failure LV systolic function is commonly determined with cardiac POCUS. All 4 POCUS cardiac views should be used to evaluate LV systolic function. The parasternal short axis view provides a doughnut view of the heart and is useful to visualize all 4 LV walls (anterior, inferior, septal and lateral). LV systolic function can be estimated by looking at: The change in size between end-diastolic and end-systolic size of the LV.  LW wall thickening during systole Endocardial border excursion in systole We can define LV systolic function into the following groups: Normal Mild to Moderate LV Systolic Failure Severe LV Systolic Failure In Image 1, there is > 50% change between the end diastolic and end systolic sizes. LV wall thickening is seen in systole and there is good endocardial border movement. Image 2 shows little change between end-diastolic and end-systolic LV size. LV wall…

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Summary Probe selection Use a phased array probe, which has a square footprint. Note the position of the orientation marker on the side of the probe. Patient position The patient is placed in the left lateral decubitus position to obtain the PLAX, PSAX and apical 4C views. The supine position can be used for the SC4C view. For the purposes of the VR simulation, the patient is placed supine for all views. protocol Cardiac POCUS is performed by obtaining the following views in sequence: Parasternal Long Axis Parasternal Short Axis Apical 4 Chamber Subcostal 4 Chamber PLAX Place the transducer in the 2nd to 4th intercostal space to the left of the sternum. The transducer orientation marker should face the patients right shoulder. PSAX From the PLAX view, keep the transducer in the same location on the chest wall. Rotate the transducer by 90 degrees clockwise so that the orientation…

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LEarning goals Position the patient Identify the surface landmarks for probe placement Correctly position & orientate the probe on the patient Obtain the Subcostal 4C view Identify the cardiac structures and chambers Patient Position Supine Knees flexed Probe Position Place the probe in the subxiphoid region, below the xiphisternum Probe orientation marker should face the patients left flank Angle the transducer to face the patient’s head Obtaining the view https://vimeo.com/835790769?share=copy All 4 cardiac chambers are seen. The mitral and tricuspid valves are seen The right heart is at the top of the display, closest to the transducer Structures and chambers seen SC4C View Answers Identify the Structures and Chambers A – Right Atrium, B- Right Ventricle C- Left Atrium D- Left Ventricle PrevPreviousApical 4 Chamber NextSummary: Cardiac POCUSNext

LEarning goals Position the patient Identify the surface landmarks for probe placement Correctly position & orientate the probe on the patient Obtain the Apical 4C view Identify the cardiac structures and chambers Patient Position Left lateral decubitus Left hand under the patient’s head Probe Position Point of maximal cardiac impulse or apex of the heart Probe orientation marker faces the patients left flank Obtaining the view https://vimeo.com/835790601?share=copy All 4 cardiac chambers are seen. The mitral and tricuspid valves are seen The right heart is on the left of the display, and the left heart on the right of the display Structures and chambers seen A4C View Answers Identify the Structures and Chambers A – Right Ventricle B- Left Ventricle, C- Right Atrium D- Left Atrium PrevPreviousParasternal Short Axis NextSubcostal 4 ChamberNext

LEarning goals Position the patient Identify the surface landmarks for probe placement Correctly position & orientate the probe on the patient Obtain the PSAX view Identify the cardiac structures and chambers Patient Position Left lateral decubitus During the VR simulation, the patient is placed in the supine position Left hand under the patient’s head Probe Position Left parasternal 2nd to 4th intercostal space Probe orientation marker faces the patient’s LEFT shoulder Obtaining the view https://vimeo.com/835790719?share=copy The LV is seen as a doughnut in its short axis All 4 LV walls are seen – Anterior, Septal, Lateral, Inferior The papillary muscles must be visible The Right Ventricle is seen to left of the display. Structures and chambers seen PSAX View Answers Identify the Structures and Chambers A – Left Ventricle B- Right Ventricle, C- Anterior LV wall D- Lateral LV wall, E- Inferior LV wall PrevPreviousParasternal Long Axis NextApical 4 ChamberNext

LEarning goals Position the patient Identify the surface landmarks for probe placement Correctly position & orientate the probe on the patient Obtain the PLAX view Identify the cardiac structures and chambers seen Patient Position Left lateral decubitus During the VR simulation, the patient is positioned supine Left hand under the patient’s head Probe Position Left parasternal 2nd to 4th intercostal space Probe orientation marker faces the patient’s right shoulder Obtaining the view https://vimeo.com/835790658?share=copy The LV walls should be parallel to each other The LV diameter is at its widest The aortic and mitral valves are seen The descending aorta is seen The apex of the heart is NOT seen Chambers: LV, RVOT, Ascending Aorta, LA Structures and chambers seen https://vimeo.com/manage/videos/782046820 PLAX View Answers Identify the Structures and Chambers A – Left Ventricle, B- Right Ventriclular Outflow Tract, C- Ascending Aorta, D- Left Atrium, E – Descending Aorta, F- Mitral Valve,…

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Cardiac acoustic windows There are 3 cardiac windows from which the 4 cardiac pocus views are obtained. The cardiac windows are shown in the image below. These are the: Parasternal Window, from which the parasternal long and short axis views are obtained. Apical Window, from which the apical 4 chamber view is obtained. Subcostal Window, from which the subcostal 4 chamber view is obtained. The image shows the 3 commonly used acoustic windows for pocus cardiac. The suprasternal notch window is not commonly used for pocus. PrevPreviousCardiac, Lung and eFAST POCUS NextParasternal Long AxisNext