How to image echo views

1. How To Move The Transducer
Displacement Rotation Angulation
NOTE: Use enough US gel!NOTE: Use enough US gel!NOTE: Use enough US gel!
Imaging Windows
Parasternal
2nd - 4th intercostal
space left sternal border
Apical
4th - 5th intercostal
space, lateral!
Subcostal Below xiphoid
Right parasternal
2nd - 4th intercostal
space, right sternal
border
Suprasternal Jugulum sternum
NOTE: Use as many views as possible including atypical views and always
image so that the pathology of interest is best seen.
NOTE: Use as many views as possible including atypical views and always
image so that the pathology of interest is best seen.
NOTE: Use as many views as possible including atypical views and always
image so that the pathology of interest is best seen.
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2. Image View
Parasternal long axis viewsParasternal long axis views
Parasternal long axis viewParasternal long axis view
Right parasternal long axisRight parasternal long axis
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3. Parasternal short axis viewsParasternal short axis views
Parasternal short axis – BaseParasternal short axis – Base
Parasternal short axis – MVParasternal short axis – MV
Parasternal short axis – Mid VentricleParasternal short axis – Mid Ventricle
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4. Apical ViewsApical ViewsApical ViewsApical Views
Rotate counterclockwiseRotate counterclockwiseRotate counterclockwise
4 chamber view 2 chamber view 3 chamber view
The orientation of the septum denotes whether you are in a lateral or medial
position relative to the true apex. Use all views to fully examine all aspects of
the left and right ventricle.
The orientation of the septum denotes whether you are in a lateral or medial
position relative to the true apex. Use all views to fully examine all aspects of
the left and right ventricle.
The orientation of the septum denotes whether you are in a lateral or medial
position relative to the true apex. Use all views to fully examine all aspects of
the left and right ventricle.
The orientation of the septum denotes whether you are in a lateral or medial
position relative to the true apex. Use all views to fully examine all aspects of
the left and right ventricle.
Orientation of the apical viewsOrientation of the apical viewsOrientation of the apical viewsOrientation of the apical views
5 chamber view5 chamber view5 chamber view5 chamber view
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5. Coronary sinus viewCoronary sinus viewCoronary sinus viewCoronary sinus view
NOTE: Avoid foreshortening, place the transducer as lateral and caudal as
possible
NOTE: Avoid foreshortening, place the transducer as lateral and caudal as
possible
NOTE: Avoid foreshortening, place the transducer as lateral and caudal as
possible
NOTE: Avoid foreshortening, place the transducer as lateral and caudal as
possible
Subcostal ViewsSubcostal Views
Subcostal 4 chamber viewSubcostal 4 chamber view
Inferior vena cava view (rotate counterclockwise)Inferior vena cava view (rotate counterclockwise)
NOTE: In some patients it is also possible to visualize the superior vena cava
in this view.
NOTE: In some patients it is also possible to visualize the superior vena cava
in this view.
Subcostal short axis view (rotate clockwise)Subcostal short axis view (rotate clockwise)
NOTE: Perform subcostal views in all patientNOTE: Perform subcostal views in all patient
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6. Subcostal ViewsSubcostal Views
Subcostal 4 chamber viewSubcostal 4 chamber view
Inferior vena cava view (rotate counterclockwise)Inferior vena cava view (rotate counterclockwise)
NOTE: In some patients it is also possible to visualize the superior vena cava
in this view.
NOTE: In some patients it is also possible to visualize the superior vena cava
in this view.
Subcostal short axis view (rotate clockwise)Subcostal short axis view (rotate clockwise)
NOTE: Perform subcostal views in all patientNOTE: Perform subcostal views in all patient
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7. Reference Values — MModeReference Values — MModeReference Values — MModeReference Values — MMode
NOTE: MMode - LA is measured in its largest extension at end-systole. Aortic
dimension is measured at end-diastole, shortly before the aortic valve opens!
NOTE: MMode - LA is measured in its largest extension at end-systole. Aortic
dimension is measured at end-diastole, shortly before the aortic valve opens!
NOTE: MMode - LA is measured in its largest extension at end-systole. Aortic
dimension is measured at end-diastole, shortly before the aortic valve opens!
NOTE: MMode - LA is measured in its largest extension at end-systole. Aortic
dimension is measured at end-diastole, shortly before the aortic valve opens!
Aorta (mm) < 40 LVEDD (mm) 42 - 59
Left atrium (mm) 30 - 40 Posterior wall (mm) 6 - 10
IVS (mm) 6 - 10 Fractional Shortening (%) > 25
Tricuspid Annular Plane
Systolic Excursion (TAPSE)
> 16mm
MAPSE (longitudinal LV
function)
> 12mm
Reference Values — DopplerReference Values — DopplerReference Values — DopplerReference Values — Doppler
Aortic valve velocity (m/sec)Aortic valve velocity (m/sec) CW 0.9 - 1.7
LVOT velocity (m/sec)LVOT velocity (m/sec) PW < 1.3
Pulmonic valve velocity (m/sec)Pulmonic valve velocity (m/sec) CW 0.5 - 1.0
Tricuspid valveTricuspid valve PW 0.3 - 0.7
Tricuspid regurgitation (m/sec)Tricuspid regurgitation (m/sec) CW 1.7— 2.3
E wave (m/sec)E wave (m/sec) PW < 1.3
Mitral annulus e‘ (cm/sec)Mitral annulus e‘ (cm/sec) TDI PW 0.8 - 1.3
Right ventricular lateral wall (cm/sec)Right ventricular lateral wall (cm/sec) TDI PW
12.2 (41-60a) /
10.4 (>60a)
Color DopplerColor Doppler
2D before color!
Look for aliasing to
detect jets
Reduce PRF to detect low
velocity flow (e.g. ASD,
PFO)
Use higher frame rates
Use multiple views
Color as guide for CW/
PW
NOTE: Don´t expect to see the full extent and size of a color Doppler jet if 2D
image quality is poor
NOTE: Don´t expect to see the full extent and size of a color Doppler jet if 2D
image quality is poor
NOTE: Don´t expect to see the full extent and size of a color Doppler jet if 2D
image quality is poor
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