POCUS and critical care echo

Core cardiac views and LV assessment

Reviewed Nov 2026·2 references
New· views rounded down, updated weekly

Obtain parasternal long and short axis, apical four-chamber and subcostal views. Grade LV function visually (normal, mildly, severely reduced, hyperdynamic) and look for pericardial effusion, gross valve failure and LV size.

At the bedside

Timed steps
  1. 1

    Phased-array probe

    Set up

    Cardiac preset; marker convention (screen marker on the right in cardiac mode). Patient supine or left lateral.

  2. 2

    Parasternal long axis

    View 1

    3rd-4th left intercostal space, marker to right shoulder. LV size and function, mitral and aortic valves, pericardial vs pleural effusion (descending aorta).

  3. 3

    Parasternal short axis

    View 2

    Rotate 90° clockwise. 'Donut' LV at papillary level: regional wall motion, septal shape (D-sign in RV overload).

  4. 4

    Apical four-chamber

    View 3

    Apex beat, marker to left. RV:LV size ratio, global function, MAPSE/TAPSE, effusion.

  5. 5

    Subcostal

    View 4

    Below xiphoid, marker to left, probe flat. Best view in ventilated patients; effusion and RA/RV collapse; then rotate for IVC.

  6. 6

    LV function

    Interpret

    Visual EF: hyperdynamic (cavity obliteration), normal, reduced, severely reduced. E-point septal separation > 7 mm suggests reduced EF.

  7. 7

    Tamponade

    Interpret

    Effusion with RA systolic collapse, RV diastolic collapse, plethoric IVC; clinical diagnosis with haemodynamic compromise.

Five-view focused cardiac scan

ViewProbe positionKey questions
PLAXLeft parasternal, 3rd-4th ICS, marker to right shoulderLV function, effusion, aortic root, MV/AV
PSAXSame site, rotate 90° clockwiseRegional wall motion, D-sign
A4CApex, marker to patient's leftRV:LV ratio, TAPSE, global function
Subcostal 4CSubxiphoid, flat probeEffusion, tamponade, global function
Subcostal IVCRotate to long axis, marker cephaladIVC size and variation
Red flag · call your senior now
Effusion with RV diastolic collapse and hypotension: tamponade → drain.
Red flag
Severely reduced LV with shock: cardiogenic shock pathway.
Pitfall
Calling epicardial fat or a pleural effusion a pericardial effusion (check relation to descending aorta).
Pitfall
Foreshortened apical views underestimating LV size.
Pearl
Hyperdynamic LV with kissing papillary muscles suggests hypovolaemia or vasodilation.

References

  1. 1

    Via G, Hussain A, Wells M, et al. International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr. 2014;27(7):683.e1-683.e33

  2. 2

    Labovitz AJ, Noble VE, Bierig M, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the ASE and ACEP. J Am Soc Echocardiogr. 2010;23(12):1225-1230

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Right ventricle assessment

Educational reference for trained clinicians. Check doses against your hospital protocol and the patient in front of you.