II. Technique: Transducer

  1. Transducer orientation
    1. Transducer placed at PMI or approximately xiphoid level (6th intercostal space) in mid-clavicular line or nipple line
      1. Identify heart apex with other views (e.g. PLAX)
    2. Transducer indicator pointed towards patient's left (3:00 position)
    3. Align energy toward right Shoulder along heart's long axis
    4. Hand holding transducer is pushed with knuckles into the bed to get best angle through heart
    5. Four chamber apical view will appear bullet shaped, oriented vertically
  2. Images
    1. UltrasoundHeartApical.jpg
    2. ultrasoundProbePositionEchoApical.jpg
    3. ultrasoundBMP_cvApical.jpg

III. Technique: Landmarks - Four chamber heart view

  1. Right ventricle
    1. Triangular appearance
    2. Does not extend to the apex
  2. Left ventricle
    1. Extends to apex (unlike right ventricle)
  3. Tricuspid valve
    1. Appears higher on the screen, closer to probe, more inferior in chest
  4. Mitral valve
    1. Trace regurgitation is common
  5. Right atrium, left atrium and descending aorta

IV. Interpretation

  1. Pericardial Effusion (best view for Pericardiocentesis)
  2. Apical thrombus (decrease depth to see, apex is closest to probe in this location)
  3. Systolic Dysfunction
  4. Wall motion abnormalities

V. Resources

  1. Apical 4-Chamber View Video (SonoSite)
    1. http://www.youtube.com/watch?v=_eHZz-OCc_M
  2. Echocardiographer
    1. http://echocardiographer.org/

VI. References

  1. Mateer and Jorgensen (2012) Introduction and Advanced Emergency Medicine Ultrasound Conference, GulfCoast Ultrasound, St. Pete's Beach
  2. Noble (2011) Emergency and Critical Care Ultrasound, Cambridge University Press, New York, p. 61-88
  3. Orman, Dawson and Mallin in Majoewsky (2013) EM:Rap 13(1): 4-6
  4. Reardon (2011) Pocket Atlas Emergency Ultrasound, McGraw Hill, New York, p. 61-106

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