Cardiac POCUS

POCUS is good for the Heart

Cardiac POCUS involves 4 basic views of the heart. These are the typical views also seen on ECHO, although formal ECHOs include many other variations of these views and other things such as ‘M’ mode & Doppler.

Now lets review each view, how to find them, and what we’re looking at.

Parasternal Long

Clinical questions:
How good (approximately) is my LV function?
Is the mitral valve normal?
Is the aortic valve normal?

Probe Positioning
Use the phase-array or curvilinear probe.
Place the probe to the left of the patients sternum.
Aim the marker towards their right shoulder.

Normal Anatomy

Parasternal Short

Clinical questions:
How good (approximately) is my LV function?
Is there a wall of the LV that is hypo- or akinetic?
Is there bowing of the intraventricular septum?
Is the mitral valve normal?
Is the aortic valve normal?

Probe Positioning
Same as above: phase-array or curvilinear probe.
Find your parasternal long view just like before.
Now rotate the marker 90°, aiming towards their left shoulder.

Normal Anatomy

Apical 4 Chamber

Clinical questions:
How good (approximately) is my LV function?
Is there a wall of the LV that is hypo- or akinetic?
What is the relationship between the LV & RV?
Is there a pericardial effusion?

Probe Positioning
Again use the phase-array or curvilinear probe.
From your parasternal short view, you can slide the probe down to the apex, then fan upwards once you’re there. Alternatively, find the PMI.
Aim the marker towards their head/left shoulder.

Normal Anatomy
*flipped from above diagram! LV = Left & RV = Right here*

Subxiphoid

Clinical questions:
How good (approximately) is my RV function?
Is there a pericardial effusion?

Probe Positioning
Again use the phase-array or curvilinear probe.
Place your probe just inferior to the patients xiphoid process in their upper abdomen. Angle (fan) your probe upwards toward their thorax/heart.
Aim the marker towards their left shoulder.

Normal Anatomy

That’s it! You made it through!
Now go out there and TRY IT!!