Module 11 : Apical Views Flashcards
1
Q
apical window
A
- anterior axillary line to the posterior axillary line in 3th or 5th intercostal space
- use PMI TO FIND APEX = 2 to 3 o clock
- endocardium lining must be seen well in the whole LV
2
Q
point of maximum impulse (PMI)
A
- palpate on the body where you feel the most heart movement
- used to find apical window
3
Q
apical 4 chamber (A4C) structures - right heart
A
- RV free wall
- RV cavity
- Moderator band
- TV
+ ANTERIOR TRICUSPID VALVE LEAFLET
+ SEPTAL TRICUSPID VALVE LEAFLET - RA
- eustachian valve
+/- IVC SVC
+/- chiari network (free floating filaments)
4
Q
apical 4 chamber (A4C) structures - left heart
A
- LV inferior septal wall
- LV anterolateral wall
- LV cavity
- MV
+ ANTERIOR MITRAL LEAFLET
+ POSTERIOR MITRAL LEAFLET - right upper pulmonary vein RUPV
- left upper pulmonary vein LUPV
+/- left atrial appendage
+/- left lower pulmonary vein
+/- coronary sinus
5
Q
Apical 5 chamber (A5C)
A
- LVOT and AO valve
- from A4C angle probe more anteriorly
- right heart structures will be lost
- both AV leaflets must be seen during both systole and diastole
- both AV leaflets must be seen to separate fully
- 5th chamber AORTA
6
Q
A5C visible structures
A
- LV apex
- IVS more anterior segment than A4C
- lateral LV wall
- LVOT
- AV
+ RIGHT AND LEFT CUSPS - prox aorta including sinus of valsalva
- part of the LA
7
Q
Apical 2 Chamber (A2C)
A
- from apical 4 rotate counterclockwise 60’
- rotate only until RV disappears
- need to see anterior wall clearly
- sometimes may need to slide up one interspace
- don’t shorten LV apex
8
Q
leaflet location in A4C
A
- posterior on the left side and anterior on right side of screen
9
Q
A2C strucutres
A
- LV apex
- LV walls
+ inferior wall
+ anterior wall
+ inferolateral pap muscle - MV
+ posterior mitral leaflet
+ anterior mitral leaflet - LA
- coronary sinus
- sometimes see
+ one or more pulmonary veins
+ Left atrial appendage (LAA) - ENDOCARDIUM MUST BE WELL SEEN IN ENTIRE LV
10
Q
apical 3 chamber (A3C)
A
- looks identical to PLAX view on its side
- rotate probe 30” counter clockwise from A2C
- rotate until the FULL LVOT and BOTH AV CUSPS
- AO sinus should be seen
11
Q
A3C structures
A
- LV apex
- LV chamber
- inferolateral pap muscle
- MV
+ ANTERIOR AND POSTERIOR CUSP - LA
- CS
- LVOT
- AV
+ RIGHT AND NON CORONARY
+/- pulmonary veins
12
Q
subcostal window
A
- pt supine with knees bent to relax abs
- 2cm inferior to to xyphoid process
- probe toward you in 3 o clock position
- must apply some downward pressure to allow th e probe to see under the rib cage
- uses liver as an acoustic window
13
Q
subcostal 4CH structures seen
A
- RV inferior wall
- TV
- IVS
- RA
- IAS
- LV
- IVS
- MV
- LA
- SVC sometime
14
Q
subcostal 4 is the best view to see what
A
ATRIAL SHUNT IS BEST SEEN IN THIS VIEW
15
Q
patent foramen ovale (PFO)
A
- occurs when the atrial foramen ovale doesnt shut all the way or isn’t there and flow between atria occurs
- BEST SEEN IN SUBCOSTAL 4 VIEW
