SoundBytes Cases: Cardiac Echocardiography - Subxiphoid View

Introduction

• Presenter: Phil Pereira, Emergency Ultrasound Coordinator
• Institution: New York Presbyterian Hospital, NYC
• Focus: Subxiphoid view of the heart in cardiac echocardiography

Overview

• Part of cardiac echo examination using four standard views
• Current module: Subxiphoid view
• Other views: Parasternal (Probe A), Apical (Probe C - upcoming module)

Subxiphoid View Technique

• Probe Positioning:
  • Place probe just inferior to xiphoid tip of sternum
  • Lay flat, push down and under sternum
  • Aim towards patient's left shoulder
  • Marker dot on probe: patient’s right side
  • Screen indicator dot: left of the screen
• Hand Technique:
  • Use hands on top of the probe
  • Push down and up for optimal imaging angle

Imaging and Anatomy from Subxiphoid View

• Ultrasound Image:
  • Acoustic window: Liver
  • Primary visible structures:
    • Right Ventricle (RV) directly below liver
    • Left Ventricle (LV) behind RV
    • Right Atrium (RA) to left of RV
    • Left Atrium (LA) to left of LV
  • Pericardium: White line surrounding the heart

Normal Heart via Subxiphoid View

• Liver seen anteriorly
• RV below liver, RA to left of RV
• Tricuspid valve visible between RA and RV
• Posterior to RV: LV with more muscular/hypertrophic walls
• LA to left of LV
• Mitral valve visible between LA and LV
• Pericardium seen as white line around heart
• Observations:
  • Good left ventricular contractility
  • No significant pericardial effusion

Pathological Cases

Advanced Cardiomyopathy

• Poorly contracting, dilated LV
• No significant pericardial effusion

Renal Failure and Pericardial Effusion

• Hypertrophic LV walls
• Dark fluid collection indicating large pericardial effusion
• Check for cardiac tamponade

Cardiac Tamponade

• Large pericardial effusion noted
• Right Ventricle (RV) compression during diastole
• Advanced cardiac tamponade indicated by chaotic RV movement
• Right side compressed first due to lower pressure circuit

Conclusion

• Importance of Subxiphoid view in routine practice
• Identifies pericardial effusion and assesses LV contractility
• Provides better views of right side of heart than parasternal views
• Encouragement to explore further echo exam planes in upcoming modules