Patient Position
o For parasternal and apical views have the patient lie in the left lateral decubitus
(LLD) position with left arm raised above the head. Obtain an adequate ECG which
includes visualization of the P wave, QRS complex, and T wave.
o For subcostal view have the patient lay on their back and bend their knees to soften
the abdominal muscles.
o For suprasternal notch view have the patient lay on their back with a pillow under
their shoulders to allow for the probe to be rotated correctly
o Capture 2 cardiac heart beats per cine loop unless an abnormal rhythm is present
o Change the number of cardiac heart beats captured from 2 to 4-5 for patients with
the following abnormalities: atrial fibrillation, significant arrhythmias, rapid heart
rate (with a R wave to R wave greater than 500 m/sec on the ECG)
o Adjust overall gain and TGC so that the ventricular and atrial cavities are anechoic
Color Doppler
o Adjust color gain until Doppler noise is seen, then decrease the gain down just
enough to eliminate the noise.
Too Correct
o Keep your color box narrow for better resolution wide
Spectral Doppler
o Perform continuous wave Doppler tracing on all valves with a velocity greater than
2m/sec
o Perform continuous wave Doppler tracing on all valve replacements and repairs
Left Acquire cine loop 2D image at a reduced depth so image fills field of view
Ventricle
(LV)
Aortic Valve M-mode sweep of aortic valve freeze and acquire DO NOT UNFREEZE THIS
(AV) IMAGE
Mitral Valve *Measure the following with the mitral valve M-mode:
(MV) E-F slope
Measure the distance of the steepest initial portion of the anterior
MV leaflet by placing a caliper on the steepest point of early
diastole and then place a caliper at the end of the slope.
Normal range is 70-150 mm/s.
E Point Septal Separation (EPSS)
Measure the vertical distance from the MV E point to the lowest
point of the IVS.
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Adult Echocardiography Protocol
Normal range is 2-7 mm.
Left M-mode sweep of left ventricle freeze and acquire DO NOT UNFREEZE THIS
Ventricle IMAGE
(LV)
Aortic and Acquire cine loop of Color Doppler across both mitral valve & aortic valve
RVIT Acquire continuous wave Doppler across the tricuspid valve IF tricuspid
regurgitation present
*RVOT Right ventricular outflow track (RVOT)
Acquire cine loop of 2D image of right ventricular outflow track (RVOT)
*RVOT Acquire cine loop of color Doppler across the pulmonary valve (PV)
*RVOT Acquire pulsed wave Doppler across the pulmonary valve and measure peak
velocity
*RVOT Acquire continuous wave Doppler across the pulmonary valve IF pulmonary
regurgitation present
AV, TV, PV Acquire cine loop of 2D image of aortic valve, tricuspid valve, and pulmonary
valve
Pulmonary Acquire cine loop of color Doppler across the Pulmonary artery/valve
Valve
Pulmonary Acquire pulse wave at pulmonary leaflet tips & measure maximum velocity.
Valve Normal range 0.6-1.0 m/s
Pulmonary Acquire continuous wave through pulmonary valve for pulmonary valve flow and
Valve pulmonary insufficiency with measurements
Aortic Valve Acquire cine loop of color Doppler across the aortic valve
not Zoomed
Tricuspid Acquire cine loop of color Doppler across the tricuspid valve for tricuspid
Valve regurgitation
Left Acquire cine loop of 2D image of left ventricle at level of the mitral valve
Ventricle &
Mitral Valve
Left Acquire cine loop of color Doppler of left ventricle at level of the mitral valve
Ventricle & across the septal wall & mitral valve
Mitral Valve
Left Acquire cine loop of 2D image of left ventricle at level of the papillary muscles
Ventricle &
Papillary
muscles
Apex of LV Acquire cine loop of 2D image of left ventricle apex
4 Chamber Acquire cine loop of color Doppler of flow across mitral valve & left atrium for
mitral regurgitation
4 Chamber Acquire pulse wave Doppler at the tips of the mitral valve leaflets and freeze
image:
Measure E to A & descending slope
Acquire image with measurement
4 Chamber Acquire continuous wave Doppler across mitral valve and freeze image:
Measure peak velocity of mitral regurgitation if present
Acquire image with measurement
4 Chamber Acquire pulse wave Doppler at the opening of the pulmonary vein and freeze
image:
Documenting the systolic and diastolic forward flow
Left Acquire 2D image with a decreased depth demonstrating the left ventricle and
Ventricle & 1/3 of the left atrium
Left Atrium
Left Acquire cine tissue Doppler imaging (TDI) of left ventricle and 1/3 of the left
Ventricle & atrium:
Left Atrium
5 Chamber Acquire cine loop 2D image of left atrium, left ventricle, aorta, right atrium, &
right ventricle
5 Chamber Acquire cine loop color Doppler across the aortic valve
RV, TV, RA Acquire cine loop of color Doppler across the tricuspid valve
RV, TV, RA Acquire continuous wave Doppler across the tricuspid valve IF tricuspid
regurgitation:
Measure tricuspid regurgitation
Acquire image with measurement
4 Chamber *Biplane Simpsons Method:
Acquire an apical 4 chamber image and freeze
Scroll to end-diastole and trace the LV cavity and store image
Measure the length of the LVED from the mid mitral annulus to the cardiac
apex and store image
This will give you the LV ED volume DO NOT UNFREEZE THE IMAGE
Scroll to end-systole and trace the LV cavity and store image
Measure the length of the LVED from the mid mitral annulus to the cardiac
apex and store image
This will give you the LV ES volume
2 Chamber Acquire cine loop of 2D image of the left atrium & left ventricle
2 Chamber Acquire cine loop of color Doppler across the mitral valve
2 Chamber Acquire cine loop of 2D image decreasing depth to demonstrate the left ventricle
& 1/3 of the left atrium
3 Chamber Acquire cine loop of 2D image of the left atrium, left ventricle, & aortic valve
3 Chamber Acquire cine loop of color Doppler across the mitral valve & aortic valve
3 Chamber Acquire cine loop of 2D image decreasing depth to demonstrate the left ventricle
& 1/3 of the left atrium
4 Chamber Acquire cine loop of 2D image of 4 chamber demonstrating the left ventricle on
the LEFT side of the SCREEN & the right ventricle on the RIGHT side of the
SCREEN (Mayo Clinic)
4 Chamber Acquire cine loop color Doppler across the Interatrial septum (IAS)
4 Chamber Acquire cine loop color Doppler across the interventicular septum
4 Chamber Acquire cine loop color Doppler across the mitral valve & tricuspid valve
IVC Acquire cine loop 2D image of inferior vena cava for collapse (change EKG to 5
beats)
Aorta Acquire cine loop 2D image of the aorta
Aortic arch Acquire cine loop 2D image of the aortic arch and descending aorta
and
Descending
aorta
Aortic arch Acquire cine loop color Doppler flow of the descending aorta
and
Descending
aorta
Aortic arch Acquire continuous wave Doppler through the descending aorta
and
Descending
aorta
Tips
Pharmaceutical Contrast
o Interrogate the aortic outflow with non-imaging pedoff probe from the suprasternal
notch window.
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Adult Echocardiography Protocol
o Reposition the patient to right lateral decubitus (RLD) position and interrogate the
aortic outflow with non-imaging pedoff probe from the right Parasternal window.
o Acquire multiple spectral Doppler waveforms from both windows and measure to
determine the highest velocity documented.
Biplane Simpsons Method of Discs: Uses the summation of the areas from the diameters of 20
cylinders or discs of equal height is used to calculate the end- diastolic volume, end-systolic
volume, stroke volume, cardiac output, cardiac index, and ejection fraction.
Labs: