1415 Principles Exam 2 (Apical, Subcostal)

Which of the following window is Apical Window?

2

What view is this?

Apical 4 Chamber

What view is this?

Apical 5 Chamber

What view is this?

Apical 2 Chamber

What view is this?

Apical 3 Chamber

For apical positioning, the patient is on their ___ side.

Left

For apical positioning, probe is aroung the ___ intercostal space in the _________

5th, point of maximum impulse region

For apical 4 chamber position, the POM is point towards ____ and beam directed superiorly towards patient’s head

3’o clock

What view is being shown?

Apical 4 chamber

What is number 1?

IAS

What is number 2?

Crux

What is 5?

AMVL

What is number 4

STVL

What can you see in A4C

Crux, ventricles, trabeculations, moderator band, false tendon, TV position, atrioventricular septm, LAA (rare), Leaflets opening and closing, coronary sinus, pulmonary artery

How can you see Coronary Sinus in A4C

Tilt the transucer posteriorly

How can you see Pulmonary Artery in A4C?

Tilt the transducer anteriorly

What new structure can be seen if tilted posteriorly?

CS

What view is this?

A4C, Focused Right Ventricle view

What is the white line?

False tendon

What determines a good A4C?

An elongated left ventricle with optimal visualization of all four chambers. Crux is centered

How to move from A4C to A5C?

-Tilt probe anteriorly until LVOT and proximal ascending aorta are seen

-Rotate the probe slightly to the left of the patient to show the mitral valve opening

-Tilting more anteriorly will show RVOT

What is different from A5C compared to A4C?

Can see LVOT, AO

What view is this?

A5C

What view is this? Tilting more anteriorly

Pulmonary artery and RVOT view

How to move from A4C to A2C?

Rotate index marker to 1’o clock or ~45-90 degrees CCW from A4C

What is 1?

RCC

What is 2

NCC

How can LCC be seen?

In PSAX

Where does A2C image plane lie between?

A4C and Apical Long Axis

What view is this?

A2C

A2C View Structures

LV –Left Ventricle

LA –Left Atrium

 Mitral valve leaflets

True anterior and inferior LV walls

 Left atrial appendage

Descending aorta

What leaflet is on the left←?

Posterior MVL

What leaflet is on the right→?

Anterior MVL

What is the right arrow point to?

LAA

What is the bottom anatomy?

DA

What view will be obtained from this?

A3C

What view is this?

A3C

What view is this?

A3C

What direction is the POM point for A3C?

12o’clock

How to obtain A3C?

Rotating 90 degrees CCW from A4C or 45 degrees from A2C

A3C is similar to the view of?

PLAX

What is bottom left wall of the image?

Basal Infero-Lateral

What is middle left?

Mid Infero-lateral

What is top left?

Apical Lateral

What is the top?

Apical Cap

What is top right?

Apical septum

What is right middle?

Mid Antero-Septal

What is bottom right?

Basal Antero-septal

Heart looks foreshortened (rounded apex) because of

transducer too high or medial

Value of Subcostal views

• Used in technically difficult patients

• Used if other windows and images are suboptimal

• COPD, ICU patients on ventilators

• Congenital heart disease (CHD)

• IAS, IVS definition

• Avoids the lungs

Subcostal view image plane and standard views

Subcostal four chamber

Subcostal short axis

Sometimes included in subcostal

IVC view

Abdominal aorta

For subcostal view patient is in ______ position

Supine

For subcostal view, what can help for a better image?

Relaxing abdominal muscle by bending the knee

For subcostal, the probe is positioned where?

Inferior to the sternum close to the midline

For subcostal, the POM is rotated where?

Approximately 3 o’clock to patient’s left side

For subcostal, how to obtain all four chambers?

Tilt scan plane anteriorly with minor rotational adjustments

For subcostal, what usually helps with image?

Patient’s deep breath, often have to push to go under the ribs

What view is this?

Subcostal

What view would be obtained here?

Subcostal 4ch View

What view is this?

Subcostal 4ch

Why is subcostal 4ch good?

Best view to access RV free wall, IVS, and IAS

Why is subcostal 4ch good for taking measurements of IVS, IAS

The ultrasound beam is perpendicular to IVS and IAS

What can be seen in subcostal 4ch

Liver appearance

4 chambers

IAS (perpendicular), IVS

MV, TV

Tilting anteriorly in subcostal 4ch will see what structures?

ROT and PV

What view is this?

Subcostal 5ch (use only if A5C is not good)

What view is this?

Subcostal view RVOT and PV

What view is this?

Subcostal Short Axis Aorta and IVC trans

How to get Aorta and IVC transverse (SAX)?

Probe perpendicular to abdomen

Which valve is subcostal view parallel to?

Tricuspid

What is subcostal view frequently used to evaluate

RVSP, VSD, ASD and tamponade

What image can be obtained from this?

Subcostal Short Axis

Transducer technique subcostal short axis

Subxiphoid position

POM 12 o’clock

Rotate probe 90 degrees ccw from s4c

Sweep patient’s left to right to get SAX

• LV apex

• Pap

• LV MV

• RVOT