In this video I am going to illustrate the protocol for performing complete and comprehensive transthoracic echocardiography, which meets the current standards of American Society of Echocardiography. I will not be going into a lot of pathological issues here so the protocol presented here is meant as a guideline and does not cover every aspect, such as off axis views. I am also going to talk basic probe position and major structures visible side by side with the protocol steps.
So when you follow the protocol you don't skip anything, you can get additional images according to the pathology found. I personally found that once I could execute the standard protocol flawlessly, I was able to add and refine additional echo scanning skills while deepening my understanding of the purpose of each echo image. So it's immensely useful to learn basic steps of protocol. We will start with parasternal long axis window followed by short axis, apical and in the end subcostal and suprasternal windows.
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Echocardiography protocol Steps | Normal Echocardiogram | Learn How to do echo in 10 min
Following are the key steps according to standard protocol:
00:41 Parasternal Long Axis (PLAX):
2D image with increased depth
2D image with decreased depth
Color Doppler on AV, MV, IVS
M- Mode on Left ventricular level, MV and Aortic root
Measure IVS, LVID and PWT in diastole and systole at MV tip level
Measure Proximal RVOT
Zoom LVOT, measure LVOT diameter, AV annulus
Zoom, color Doppler on Aortic Root, measure at Sinus of Valsalva, SinoTubular Junction and at ascending aorta level
LA diameter in 2D image
01:31 RV Inflow View:
2D Image
Color on TV
CW on TV
02:00 RV outflow View:
2D Image
Color on pulmonary valve
CW on Pulmonary Valve
02:55 Parasternal Short Axis (PSAX)
At the level of great vessels
03:06 At Aortic Valve Level
2D image
Zoom/Focus on TV
Color on TV
CW on TV
Zoom/Focus on PV
Color on PV
CW on PV
Zoom image of LA Appendage
03:50 At Mitral Valve Level
2D Image
Color on MV
At Papillary Muscle Level
2D image
04:48 Apical Four Chamber View:
2D Image
Zoom at Ventricular level
Zoom/Focus on MV
Color on MV
CW on MV
PW at MV tips
TDI Septal and Lateral Mitral annulus
Color on Pulmonary veins
PW on Pulmonary veins
LA Volume in end-Systole
RV Focused View in 2D
Color on TV
CW on TV
RA Area and RA Volume in end systole
TDI of lateral annulus of TV for S'
M Mode of lateral annulus of TV for TAPSE
RV Area in end diastole and end systole for FAC
RV dimensions in end diastole (At Base, mid and mid annulus to apical level)
Apical Three Chamber View:
2D Image
Color on LVOT and AV
CW on AV for IVRT
PW in LVOT
Apical Two Chamber View:
2D Image
Color on MV
Subcostal View: (SC)
Four chamber view in 2D
Color on IAS
PW on IAS
IVC and Hepatic Veins in 2D and Color Doppler
PW Doppler on Hepatic Veins
Measure IVC Diameter in end diastole
Measure IVC collapsibility index
2D image of Abdominal Aorta
Color on Abdominal Aorta
PW Doppler on Abdominal Aorta
Supraternal View:
2D Image
Color on Ascending Aorta
PW on Ascending Aorta
Color on Descending Aorta
PW on Descending Aorta
CW on Descending aorta
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