Cardiac

Introduction:

Bedside cardiac ultrasound is useful in the setting of trauma as well as medical illness. The most basic assessments of cardiac activity (or standstill) and the presence of pericardial fluid or tamponade can be made rapidly and alter patient management. Advanced cardiac ultrasound assessments can include a rough estimation of global cardiac contractility (normal vs. hypocontractile), or incorporation of ultrasound into ACLS algorithms (to confirm asystole or detect a possible cause for PEA).

Focused Questions:

  1. Is there cardiac activity?
  2. Is there a pericardial effusion?

Video Overview:

Required Views:

At least two views are required, taken from the following possible views.

1. Subxiphoid four-chamber view

Probe position Image
sub x Cardiac ussubxneg Cardiac
Notes
  • Both the anterior and posterior pericardium should be visualized
  • Parasternal views should be attempted if the subxiphoid view is not adequate
Abnormal Studies (click to enlarge)
subx2.thumbnail Cardiac

2. Parasternal long axis view

Probe position Image
cardpara long Cardiac uslong Cardiac
Notes
  • Both the anterior and posterior pericardium should be visualized
  • In the ideal plane, the mitral and aortic valves will be visible, as well as a long view of the left ventricle
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3. Parasternal short axis view

Probe position Image
cardpara short Cardiac usshort Cardiac
Notes
  • The left ventricle will generally appear as a ring, with the right ventricle more anterior
Abnormal Studies (click to enlarge)
short1.thumbnail Cardiac

4. Apical four-chamber view

Probe position Image
apicalview Cardiac usapex Cardiac
Notes
  • Though¬†rarely useful in the emergency department, this view allows easy comparison of left and right ventricles
  • All four chambers should be visible in this plane
Abnormal Studies (click to enlarge)
apex1.thumbnail Cardiac