Basic Cardiac Ultrasound

By Maria Tama, MD, RDMSUltrasound Division

Back to basics: the four core cardiac ultrasound views

Continuing a cardiology theme, this edition returns to the basics of bedside cardiac ultrasound: how to get each standard view and what to look for in each.

Parasternal long axis (PSL)

• Probe position: start at the 4th intercostal space, keeping the probe medial, close to the sternum. The marker orientation is shown in the PDF.

• What to look for:

  • LV systolic function

  • Pericardial effusion

  • Aortic root size

  • Mitral valve motion

Figure 1. Parasternal long-axis view.

Parasternal short axis (PSS)

• Probe position: from an ideal PSL view, rotate the probe toward the patient's left shoulder.

• What to look for:

  • RV size

  • Septal flattening (the "D-sign")

  • Wall motion abnormalities

Figure 2. Parasternal short-axis view.

Apical 4-chamber (A4C)

• Probe position: marker toward the patient's left, just inferior to the left nipple.

• What to look for:

  • RV:LV size comparison

  • Global LV function

  • Valvular motion

Figure 3. Apical 4-chamber view.

Subxiphoid (SX)

• Probe position: marker toward the patient's left, just below the xiphoid process.

• What to look for:

  • Pericardial effusion

  • Relative chamber sizes

Figure 4. Subxiphoid view.

Quick reference

View	Where	Key questions
PSL	4th ICS, close to the sternum	LV function, effusion, aortic root, mitral valve
PSS	Rotate from PSL toward left shoulder	RV size, septal flattening, wall motion
A4C	Below left nipple, marker to patient's left	RV:LV ratio, global LV function, valves
Subxiphoid	Below xiphoid, marker to patient's left	Effusion, relative chamber sizes

Clinical pearls

• No single view answers every question. Use at least two views to confirm a finding.

Resource

• Basic Cardiac Ultrasound (PDF, with probe positions and images)

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