Bedside Echocardiography

Rob Churchill

Where to find an Ultrasound

  • MICU: Ask nurses on JAT
  • 7JAT: moves around, would ask staff on floor
  • VA ICU: In front of resident workspace
  • VA Wards: in hospitalist workroom on 2N (door code 5140*), can be signed out
  • 6MCE: ask nurses, can be signed out and sued on MCE or VUMC floors
  • CCU/7N only: Normally in work room in CCU, can ask nurses
  • Round wing: 5th floor, ask nurses

TTE Standard Views

Additional Resources:

Parasternal long

Parasternal Long

  • Probe position: Rotate probe 180 degrees with right edge of probe/probe marker pointing toward pt’s left shoulder.
  • Make sure probe is centered over mitral valve (In right spot if you can see MV and AV).

E Point Septal Separation (EPSS)

  • Distance separating the anterior MV leaflet from the septal wall as measure of LV systolic function (easy evaluation of systolic function).
  • Place M mode spike at tip of mitral leaflet and hit M mode (perpendicular to septum).
  • Identify E point (passive filling of LV) and determine distance from interventricular septum (IVS).
    • <7mm = Normal
    • >10mm = HF
  • Confounders that elevate EPSS: AR, MS.

Parasternal Short

  • Probe position: Rotate probe 180 degrees with right edge of probe/probe marker pointing toward
    pt’s left shoulder.
  • Good position to assess EF by visualizing wall thickening.

Apical Four Chamber

  • Probe position: Slide down and look near pt’s left nipple (or in the intermammary fold after
    lifting up breast tissue if needed - at PMI if able to palpate).
  • Good for qualitative systolic function by visualizing cardiac shortening.

Subxiphoid

  • Probe position: Push probe head into pt’s abdomen just below xiphoid and flatten probe to make nearly parallel to pt’s position, marker to pt’s left.
  • Troubleshooting: shift probe slightly left of midline (toward pt’s right) and angle toward heart/right to use liver as acoustic window or ask pt to take big breath (moves heart closer to probe).
  • Best window to visualize pericardial effusion.
Diagram for Cardiology Subxiphoid procedure.

IVC

  • Probe position: subxiphoid area with probe marker facing toward pt’s head tilted slightly left of midline, trace IVC into RA to verify correct vessel (vs aorta).
  • IVC size and collapsibility used as a surrogate for CVP and RAP.
    • <2.1cm and >50% collapse: RAP ~3 mmHg.
    • <2.1cm and < 50% collapse or >2.1cm and >50% collapse: RAP ~8 mmHg.
    • >2.1cm, <50% collapse: RAP ~ >15 mmHg.
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