Cardiac ultrasound
Background
- Only ED US when probe marker will be pointing to the left (parasternal views)
- Use phased array probe
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
Source
Sonosite Uptodate