Module 1: Apical 5 Chamber + Apical 2 Chamber + Apical 3 Chamber Views 2D Protocol

Question 1

How do we get to Apical 5 chamber view?

Answer 1

Angle superiorly from A4C
sometimes a slight rotation helps

Question 2

What must we see in the A5C?

Answer 2

1. We must see from LV through AV into ASC aorta clearly
2. Must see AV leaflets opening and closing

Question 3

What is it okay to not see in Apical 5 chamber view?

Answer 3

All chambers

Question 4

What are some tips to getting A2C? 2

Answer 4

1. Use breathing to you advantage! Respiratory variations help see anterior wall clearly.
   PT holds their breath out and Tiny sniff in and hold
2. Also we may need to rest the probe on the top of the rib more than you think

Question 5

How should the A2C view look?

Answer 5

Make it long and lean

Question 6

If we start to see RV during A2C what should we do?

Answer 6

Keep rotating

Question 7

What should we do if we start to see AV during A2C?

Answer 7

1. Rotate back a bit
2. Angle out laterally

Question 8

What are some trademark anatomy we see in A2C? 2

Answer 8

1. Length of the Descending aorta
2. LAA very well seen

Question 9

What are some tips for taking A2C LA trace?2

Answer 9

1. Optimize 2D first.
2. LA is largest here

Question 10

What is the normal LAVI?

Answer 10

<34 ml/m^2

Question 11

What are some tips to get A2C reduced depth? 4

Answer 11

1. Bring dept to just below MV/ mid LA
2. Optimize LV walls to assess wall motion
3. Focus up @ mid LV
4. Colour map might help

Question 12

What are some tips to get A2C LV trace Simpsons End Diastole? 6

Answer 12

1. Keep reduced depth
2. Make sure LV is at the largest
3. Annulus to Annulus trace
4. Exclude the pap muscles
5. Adjust the vertical axis from MV annulus to the apex
6. End R wave

Question 13

What are some tips to get A2C LV trace simpsons trace for End systole? 4

Answer 13

1. Keep reduced depth
2. Make sure LV is at its smallest
3. Trace the same method as the others
4. End T Wave

Question 14

How do we get A3C?

Answer 14

Rotate the probe approx 30 degrees counter clockwise from the A2C view or 90 from A4C
Looks identical to the PLAX view turned on its side

Question 15

What are some tips for a good A3C image? 4

Answer 15

1. AV+ MV leaflets clearly seen
2. Endocardium defined
3. Should be able to see some of the ascending aorta
4. Focus at MV level

Question 16

What would make a good A3C reduced depth image? 3

Answer 16

1. Depth reduced to just below MV
2. Focus mid LV- apex
3. Endocardium must be clearly seen
   Do not foreshorten LV