Echo Made Easy - Chapter 4

Question 1

Why are better images obtained during expiration?

Answer 1

Less air-tissue interface

Question 2

What frequency is used for echo in adults?

And in children? Why the difference?

Answer 2

Adults - 2.5-3.5 MHz

Children - 5.0MHz (more superficial)

Question 3

Which correspond to these probe placements?

Answer 3

Question 4

Give three patient factors that can make TTE difficult?

Answer 4

– severe morbid obesity
– chest wall deformity
– pulmonary emphysema.

Question 5

Transducer position to obtain parasternal long-axis view?

Marker dot position?

Answer 5

Transducer position: left sternal edge; 2nd–4th space

Marker dot direction: points towards right shoulder

Question 6

Which view do most echo studies begin with?

Answer 6

Parasternal Long Axis (PLAX)

Question 7

Answer 7

Question 8

Transducer position to obtain parasternal short axis views?

Marker dot direction?

How are cuts at different levels obtained? How is this process known?

What are the levels (5)?

Answer 8

Transducer position: left sternal edge; 2nd–4th space
Marker dot direction: points towards left shoulder (90° clockwise from PLAX)
By tilting the transducer on an axis between the left hip and right shoulder, short-axis cuts are obtained at different levels, from the aorta to the LV apex (Fig. 4.3).
This angulation of the transducer from the base to apex of the heart for short-axis views is known as “bread-loafing

1. pulmonary artery
2. aortic valve level
3. mitral valve level
4. papillary muscle
5. left ventricle.

Question 9

Answer 9

Question 10

Answer 10

Question 11

Answer 11

Question 12

Answer 12

Question 13

Answer 13

Question 14

Transducer position to obtain apical 4 chamber view?

Marker dot direction?

Answer 14

• Transducer position: apex of the heart
• Marker dot direction: points towards left shoulder.

Question 15

Answer 15

Question 16

Transducer position to obtain apical 5 chamber view?

Marker dot direction?

Answer 16

• The A5CH view is obtained after the A4CH view by slight
downward tilting of the transducer. The 5th chamber added
is the left ventricular outflow tract (LVOT).

• Transducer position: apex of the heart
• Marker dot direction: points towards left shoulder.

Question 17

Answer 17

Question 18

Transducer position for subcostal view?

Marker dot position?

Patient position? When are best images obtained?

Answer 18

• Transducer position: under the xiphisternum
• Marker dot position: points towards left shoulder.

• The subject lies supine with the head held slightly low, feet
planted on the couch and the knees slightly flexed.
• Better images are obtained with the abdomen relaxed and
during the phase of inspiration.