The Basic Cardiac Windows 

In POCUS, cardiac assessment relies on five standard views that can be used based on the clinical context: the parasternal long axis (PLAX), parasternal short axis (PSAX), apical four chamber, subxiphoid four chamber, and inferior vena cava (IVC) views.

We will review the basics of how to obtain each of the basic cardiac windows and highlight the anatomy seen in each view.

 

Emergency VS Cardiology Probe Conventions

Of note, there is often confusion regarding cardiac PoCUS in those beginning the skill as cardiologists and ICU use unique probe conventions that differ from the conventional probe and screen orientation that people are familiar with from other exam types. PoCUS practitioners view the heart in one of two ways: some choose to continue to use “emergency conventions” in which the probe marker and screen marker remain oriented to the patients right, where other PoCUS practitioners have chosen to adopt “cardiology or ICU conventions” in which the screen marker is on the right and the probe marker varies. 

While learners may choose either approach, we recommend familiarizing yourself with the cardiology convention, as it represents a higher-level standard that, while more challenging at first, offers long-term benefits in advanced imaging and interpretation. The emergency convention may be simpler and more intuitive for junior learners but is not commonly used outside of the emergency department setting. The notable exception is its standardized use for assessing pericardial effusion during the eFAST exam. 

This tutorial will cover obtaining windows in both cardiology/ICU and emergency conventions as seen in patients with a typically oriented heart. Dextrocardia and congenital heart disease will not be addressed.