Echocardiographic views-

Recognition and Interpretation

Dr M. Sheeraz Alam
DM Cardiology SR1
J.N Medical College
A.M.U Aligarh
 A comprehensive transthoracic echocardiographic examination will include two-dimensional
imaging, Doppler imaging, and M mode imaging.

 With increasing frequency, three-dimensional imaging is considered a component of a

comprehensive examination, supplementing the two-dimensional study.

 2D Echo- Non Invasive test to assess the different parts of the heart with the help of sound
vibrations. It checks damages, blockages and blood flow rates.

 Doppler imaging- it measures the speed and direction of the blood flow within the heart.

 M mode imaging- the density and position of all tissues in the path of a narrow ultrasound beam
are displayed as a function of time.
 Echocardiographic views
 Parasternal long axis view
 Parasternal short axis view
 Apical view
 Subcostal view
 Suprasternal view
 Doppler evaluation of the parasternal long-axis view is useful to record blood flow through the
mitral and aortic valves .

 Because the flow of blood is not parallel to the ultrasound beam, quantitation of flow velocities
is generally not possible.

 However, color flow Doppler from this view is routinely used to detect aortic or mitral
regurgitation.
Parasternal short axis view
Aortic Valve level
 A- Trivial PR
B- Bifurcation of Pulmonary A
 By moving the transducer to a lower interspace and angling the scan plane more apically, the
image will sweep through the papillary muscle level and then the left ventricular apex.

 This series of views is ideal for assessing the contractile pattern of the left ventricle at the
midventricular and apical levels.
 Allows optimal recording of mitral leaflet excursion, mid left ventricular wall motion, and
visualization of a portion of the right ventricle.

 The normal interventricular septal curvature can be appreciated and any abnormalities of septal
position, shape, or motion can be assessed.

 Minor base-to-apex angulation is useful to record the orifice of the mitral valve, the coaptation
of the leaflets, and the mitral chordae and their insertion into the anterolateral and
posteromedial papillary muscles.

 In addition to the annulus, the aortic valve, left atrium, interatrial septum, right atrium, tricuspid
valve, right ventricular outflow tract, pulmonary valve, and proximal pulmonary artery can also
be recorded.
`
Normal Variants
 Apical 5 chamber view
 The AP5CH view is obtained from this view by slight anterior angulation of the transducer
towards the chest wall.
 The LVOT can then be visualized.
 Transducer position: suprasternal notch

 Marker dot direction: points towards left jaw

 The subject lies supine with the neck hyperextended.

 The head is rotated slightly towards the left.

 The position of arms or legs and the phase of respiration have no bearing on this echo window
 Atypical Views
 Right parasternal location- This position is useful to examine the aorta or interatrial septum and
is also useful in patients with congenital malposition of the heart e.g. dextrocardia. It plays a
major role in the assessment of aortic stenosis. This approach usually requires positioning the
patient in the right lateral decubitus position.

 Right Supraclavicular fossa- right supraclavicular examination often provides the best
opportunity to visualize the superior vena cava.

 Right Apical view

 Back
 The standard patient positions and transducer locations serve only as a general guide, applicable
to most patients.

 In patients with chest deformities, such as pectus excavatum, or those with chronic obstructive
lung disease, these standard approaches may be inadequate.

 Likewise, some anomalies within the thorax, including dextrocardia, pleural effusion, and
pneumothorax may also render the standard approaches ineffective.
Thank You