Part I Examination




1 Imaging and Patient Position



1. 1 Transducer and Imaging Planes



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Fig. 1.1 Top: The phased-array transducers commonly used in echocardiography bear markings to indicate the scan plane. Bottom: The transducer can be tilted (green arrows) and rotated (yellow arrows) to obtain various imaging planes.



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Fig. 1.2 Top: Ultrasound beam transecting the heart: The right ventricle is closest to the transducer, and the left ventricle and mitral valve are further behind. Bottom: Corresponding monitor image: The projection of the right ventricle (located ventrally) is seen at the top.



1. 2 Examining Situation



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Fig. 1.3 Top: The cardiac ultrasound unit is usually positioned to the left of the examining table. Bottom: The examiner should be seated comfortably on a swivel stool.



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Fig. 1.4 Top: For the parasternal and apical windows, the patient should lie in the left lateral decubitus position. Bottom: For the suprasternal and subcostal windows, the patient should lie in the supine position.



1. 3 Four Acoustic Windows for Imaging the Heart



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Fig. 1.5 Top: For the parasternal window, the patient lies in the left lateral position with the left arm behind his or her head. The acoustic window is situated in the fourth intercostal space just to the left of the sternum. Bottom: For the apical view (with the patient once again in the left lateral position) the beam is directed from the apical impulse.



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Fig. 1.6 Top: For the suprasternal window the patient lies in the supine position. The beam is directed from the suprasternal notch toward the aortic arch. Bottom: For the subcostal window (with the patient once again in the supine position), the heart is imaged from below.



2 Parasternal Long-Axis View



2. 1 Transducer Position and Imaging Plane



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Fig. 2.1 Top: Parasternal long-axis view: Coming from the fourth intercostal space just left of the sternum (the window/orifice allowing free access past the lung is merely the size of a postage stamp) the transducer is aimed perpendicularly toward the spine. Bottom: The plane of the beam runs between the axilla and lower left costal arch.



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Fig. 2.2 Top: The ultrasound plane displays a longitudinal section of the heart from the tip of the ventricle to the aorta.


Bottom: The right ventricle is displayed at the top and the left cardiac structures below.



2. 2 Anatomical Structures



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Fig. 2.3 Top: The aortic bulb seen just at the right of the center of the image can be used to check orientation; beneath it is the mitral valve and to its left is the left ventricle. Bottom: The right ventricle is seen near the transducer. The left ventricle is on the left and the aortic valve is just at the right of the center.



2. 3 Image Adjustment



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Fig. 2.4 If no cardiac structures are visible, the transducer should be moved directly toward the sternum (top) or the beam should be directed through a lower intercostal space (bottom).



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Fig. 2.5 Top: If too much of the left ventricle is visible, the imaging plane should be tilted craniad, i.e., the transducer cord moved toward the left iliac crest. Bottom: Imaging plane tilted too far caudad: Only the left ventricle is visible.



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Fig. 2.6 Top: If too much of the ascending aorta is visualized, the imaging plane can be tilted caudad, i.e., the transducer cord moved toward the right shoulder. Bottom: Imaging plane tilted too far craniad: Predominating view of ascending aorta.



3 Parasternal Short-Axis View


Nov 10, 2021 | Posted by in CARDIOLOGY | Comments Off on Part I Examination
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