<p begin="00:00:07.459" end="00:00:09.119" style="s2">- [Voiceover] A phased array transducer</p>
<p begin="00:00:09.119" end="00:00:11.852" style="s2">with a cardiac exam<br />type is used to perform</p>
<p begin="00:00:11.852" end="00:00:15.084" style="s2">the parasternal short<br />axis view of the heart.</p>
<p begin="00:00:15.084" end="00:00:18.007" style="s2">If possible, place the<br />patient in a left lateral</p>
<p begin="00:00:18.007" end="00:00:21.500" style="s2">decubitus position to<br />reduce any lung artifact</p>
<p begin="00:00:21.500" end="00:00:24.866" style="s2">and to bring the heart closer<br />to the anterior chest wall.</p>
<p begin="00:00:24.866" end="00:00:27.393" style="s2">Place the transducer<br />at the third or fourth</p>
<p begin="00:00:27.393" end="00:00:31.262" style="s2">intercostal space immediately<br />left of the sternum.</p>
<p begin="00:00:31.262" end="00:00:34.455" style="s2">Move between the third and<br />fourth intercostal space</p>
<p begin="00:00:34.455" end="00:00:38.127" style="s2">and slide the transducer toward<br />and away from the sternum</p>
<p begin="00:00:38.127" end="00:00:40.961" style="s2">to identify the optimal scanning window.</p>
<p begin="00:00:40.961" end="00:00:43.757" style="s2">Assuming the short axis of<br />the heart to be positioned</p>
<p begin="00:00:43.757" end="00:00:45.991" style="s2">on a plane from the<br />patient's right shoulder</p>
<p begin="00:00:45.991" end="00:00:47.457" style="s2">to the left hip.</p>
<p begin="00:00:47.457" end="00:00:49.349" style="s2">Rotate the transducer to adjust</p>
<p begin="00:00:49.349" end="00:00:52.084" style="s2">for the body habitus of the patient.</p>
<p begin="00:00:52.084" end="00:00:54.458" style="s2">The orientation marker<br />will be at approximately</p>
<p begin="00:00:54.458" end="00:00:56.443" style="s2">the two o'clock position.</p>
<p begin="00:00:56.443" end="00:00:59.555" style="s2">As an alternative approach,<br />this exam may be performed</p>
<p begin="00:00:59.555" end="00:01:02.883" style="s2">using an abdomen exam type<br />with an orientation marker</p>
<p begin="00:01:02.883" end="00:01:05.400" style="s2">to the patient's left<br />side at approximately</p>
<p begin="00:01:05.400" end="00:01:07.650" style="s2">the eight o'clock position.</p>
<p begin="00:01:11.625" end="00:01:13.778" style="s2">The myocardium will appear gray</p>
<p begin="00:01:13.778" end="00:01:17.599" style="s2">and the blood-filled chambers<br />will appear hypoechoic.</p>
<p begin="00:01:17.599" end="00:01:20.165" style="s2">The left ventricle will<br />appear as a doughnut shape</p>
<p begin="00:01:20.165" end="00:01:21.924" style="s2">in the center of the image.</p>
<p begin="00:01:21.924" end="00:01:25.905" style="s2">The anterior, septal,<br />inferior, and posterior</p>
<p begin="00:01:25.905" end="00:01:29.304" style="s2">lateral walls of the<br />ventricle can be identified.</p>
<p begin="00:01:29.304" end="00:01:32.414" style="s2">The mitral valve will be<br />seen in cross section.</p>
<p begin="00:01:32.414" end="00:01:35.839" style="s2">From this position, the<br />transducer can be tilted upward</p>
<p begin="00:01:35.839" end="00:01:39.756" style="s2">to visualize the aortic<br />valve in cross section.</p>
<p begin="00:01:41.591" end="00:01:44.146" style="s2">End downward to visualize the myocardium</p>
<p begin="00:01:44.146" end="00:01:45.882" style="s2">of the left ventricle.</p>
<p begin="00:01:45.882" end="00:01:48.959" style="s2">Note the wall motion of<br />the myocardial segments</p>
<p begin="00:01:48.959" end="00:01:51.209" style="s2">and function of the valves.</p>

<p begin="00:00:07.106" end="00:00:08.866" style="s2">- [Voiceover] A phased array<br />transducer with a cardiac</p>
<p begin="00:00:08.866" end="00:00:12.916" style="s2">exam type, is used to<br />perform parasternal long axis</p>
<p begin="00:00:12.916" end="00:00:14.778" style="s2">view of the heart.</p>
<p begin="00:00:14.778" end="00:00:17.654" style="s2">If possible, place the<br />patient in a left lateral</p>
<p begin="00:00:17.654" end="00:00:21.151" style="s2">decubitus position to<br />reduce any lung artifact,</p>
<p begin="00:00:21.151" end="00:00:24.731" style="s2">and to bring the heart closer<br />to the anterior chest wall.</p>
<p begin="00:00:24.731" end="00:00:27.664" style="s2">Place the transducer at the<br />third, or fourth, intercostal</p>
<p begin="00:00:27.664" end="00:00:31.090" style="s2">space immediately left of the sternum.</p>
<p begin="00:00:31.090" end="00:00:33.750" style="s2">Move between the third, and<br />fourth intercostal space,</p>
<p begin="00:00:33.750" end="00:00:37.596" style="s2">and slide the transducer toward,<br />and away from the sternum</p>
<p begin="00:00:37.596" end="00:00:40.566" style="s2">to identify the optimal scanning window.</p>
<p begin="00:00:40.566" end="00:00:43.524" style="s2">Assuming the long axis of the<br />heart to be positioned on a</p>
<p begin="00:00:43.524" end="00:00:46.849" style="s2">plane from the patients right<br />shoulder to left hip, rotate</p>
<p begin="00:00:46.849" end="00:00:49.196" style="s2">the transducer to adjust for the body</p>
<p begin="00:00:49.196" end="00:00:51.410" style="s2">habitus of the patient.</p>
<p begin="00:00:51.410" end="00:00:53.859" style="s2">The orientation marker,<br />will be at approximately</p>
<p begin="00:00:53.859" end="00:00:56.177" style="s2">the 10 o'clock position.</p>
<p begin="00:00:56.177" end="00:00:59.571" style="s2">As an alternative approach,<br />this exam may be performed using</p>
<p begin="00:00:59.571" end="00:01:02.742" style="s2">an abdomen exam type, with<br />the orientation marker</p>
<p begin="00:01:02.742" end="00:01:05.027" style="s2">to the patients right<br />side at approximately</p>
<p begin="00:01:05.027" end="00:01:06.944" style="s2">the 4 o'clock position.</p>
<p begin="00:01:11.288" end="00:01:14.255" style="s2">They myocardium will appear<br />gray, and the blood filled</p>
<p begin="00:01:14.255" end="00:01:17.073" style="s2">chambers will appear hypoechoic.</p>
<p begin="00:01:17.073" end="00:01:20.146" style="s2">The descending aorta is seen<br />in cross section as a round</p>
<p begin="00:01:20.146" end="00:01:24.539" style="s2">structure posterior to the<br />atrioventricular junction.</p>
<p begin="00:01:24.539" end="00:01:27.664" style="s2">This view is used to evaluate<br />the right ventricle, left</p>
<p begin="00:01:27.664" end="00:01:31.331" style="s2">ventricle outflow tract,<br />and left ventricle.</p>
<p begin="00:01:31.331" end="00:01:33.811" style="s2">Note overall activity of the heart.</p>
<p begin="00:01:33.811" end="00:01:37.211" style="s2">Any wall motion abnormality,<br />valve abnormalities,</p>
<p begin="00:01:37.211" end="00:01:40.628" style="s2">and the presence of pericardial effusion.</p>

<p begin="00:00:07.145" end="00:00:09.034" style="s2">- [Voiceover] A phased array transducer</p>
<p begin="00:00:09.034" end="00:00:11.398" style="s2">with a cardiac exam<br />type is used to perform</p>
<p begin="00:00:11.398" end="00:00:14.044" style="s2">the apical four chamber view of the heart.</p>
<p begin="00:00:14.044" end="00:00:16.203" style="s2">If possible, place the patient</p>
<p begin="00:00:16.203" end="00:00:18.549" style="s2">in a left-lateral decubitus position</p>
<p begin="00:00:18.549" end="00:00:21.190" style="s2">to reduce any lung artifact<br />and to bring the heart</p>
<p begin="00:00:21.190" end="00:00:23.645" style="s2">closer to the anterior chest wall.</p>
<p begin="00:00:23.645" end="00:00:25.659" style="s2">Place the transducer at the apex</p>
<p begin="00:00:25.659" end="00:00:27.843" style="s2">or point of maximum impulse,</p>
<p begin="00:00:27.843" end="00:00:30.226" style="s2">with the orientation<br />marker to the patient's</p>
<p begin="00:00:30.226" end="00:00:32.892" style="s2">left side at a three o'clock position.</p>
<p begin="00:00:32.892" end="00:00:35.499" style="s2">As an alternative<br />approach, this exam may be</p>
<p begin="00:00:35.499" end="00:00:37.954" style="s2">performed using an abdomen exam type,</p>
<p begin="00:00:37.954" end="00:00:42.421" style="s2">with the orientation marker<br />to the patient's right side.</p>
<p begin="00:00:42.421" end="00:00:44.588" style="s2">Aim to the right shoulder.</p>
<p begin="00:00:47.866" end="00:00:50.113" style="s2">The apex of the heart is visualized</p>
<p begin="00:00:50.113" end="00:00:52.001" style="s2">closest to the transducer.</p>
<p begin="00:00:52.001" end="00:00:54.267" style="s2">The myocardium will appear gray,</p>
<p begin="00:00:54.267" end="00:00:57.939" style="s2">and the blood-filled chambers<br />will appear hypoechoic.</p>
<p begin="00:00:57.939" end="00:01:00.250" style="s2">The ventricles are in the near field,</p>
<p begin="00:01:00.250" end="00:01:03.429" style="s2">and the atria are in the<br />far field of the image.</p>
<p begin="00:01:03.429" end="00:01:06.094" style="s2">This view is used to compare<br />the size of the right</p>
<p begin="00:01:06.094" end="00:01:09.410" style="s2">and left ventricles and<br />evaluate contractility.</p>
<p begin="00:01:09.410" end="00:01:11.504" style="s2">The right side of the heart,</p>
<p begin="00:01:11.504" end="00:01:14.305" style="s2">which is located on the<br />left side of the screen,</p>
<p begin="00:01:14.305" end="00:01:16.631" style="s2">should be smaller than the left.</p>
<p begin="00:01:16.631" end="00:01:19.589" style="s2">Th apical, septal, and lateral walls</p>
<p begin="00:01:19.589" end="00:01:23.756" style="s2">of the left ventricle are<br />visualized in this view.</p>