100 Echocardiography Clips with Interesting Findings Part 3

Watch the above video : Compilation of 100 Echocardiography Clips with Interesting Findings

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INTRODUCTION TO ECHOCARDIOGRAPHIC VIEWS

Transthoracic echocardiography (TTE) evaluates cardiac structure, function, and hemodynamics using standardized acoustic windows. Correct acquisition and interpretation of each view are essential, as specific pathologies are best identified in specific planes.

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PARASTERNAL LONG AXIS VIEW (PLAX)

Structures Visualized

Left ventricle (LV)

Interventricular septum (IVS)

Posterior wall

Mitral valve (MV)

Aortic valve (AV)

Left atrium (LA)

Pericardium

Key Measurements

LV internal diameter (diastole & systole)

Septal and posterior wall thickness

Ejection fraction (qualitative)

Common Pathologies Detected

Left ventricular hypertrophy (concentric or asymmetric)

Dilated cardiomyopathy (LV dilation, poor systolic function)

Mitral valve prolapse

Aortic valve calcification and stenosis

Pericardial effusion (posterior echo-free space)

Hypertrophic cardiomyopathy (septal hypertrophy, SAM)

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PARASTERNAL SHORT AXIS VIEW (PSAX)

Levels Assessed

Aortic valve level

Mitral valve level

Papillary muscle level

Apical level

Key Findings by Level

Aortic valve level: Number of cusps, opening pattern

Mitral valve level: Fish-mouth appearance

Papillary muscle level: Regional wall motion

Apical level: LV cavity obliteration

Common Pathologies

Regional wall motion abnormalities (ischemia/infarction)

Hypertrophic cardiomyopathy (asymmetric hypertrophy)

Right ventricular pressure overload (septal flattening – D-shaped LV)

Ventricular septal defects

Pulmonary hypertension signs

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APICAL FOUR-CHAMBER VIEW (A4C)

Structures Visualized

Left and right ventricles

Left and right atria

Mitral and tricuspid valves

Interatrial and interventricular septum

Quantitative Assessments

LV and RV systolic function

Chamber sizes

TAPSE (RV function)

Doppler inflow patterns

Common Pathologies

Dilated cardiomyopathy (4-chamber dilation)

Valvular regurgitation (MR, TR)

Atrial septal defect (color Doppler shunt)

Atrial enlargement (AF-related changes)

RV dysfunction in pulmonary embolism

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APICAL TWO-CHAMBER VIEW (A2C)

Structures Visualized

Left ventricle

Left atrium

Anterior and inferior LV walls

Key Uses

Biplane ejection fraction calculation

Regional wall motion analysis

Common Pathologies

Inferior or anterior wall myocardial infarction

LV apical thrombus

Left atrial enlargement

Mitral regurgitation jet direction

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APICAL THREE-CHAMBER VIEW (A3C / APICAL LONG AXIS)

Structures Visualized

LV

LA

Mitral valve

Aortic valve

LVOT

Common Findings

Aortic stenosis and regurgitation

LVOT obstruction

Mitral valve pathology

SAM in hypertrophic cardiomyopathy

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SUBCOSTAL VIEW

Advantages

Useful in COPD and mechanically ventilated patients

Best for pericardial effusion and IVC assessment

Key Findings

Pericardial effusion and tamponade

IVC size and collapsibility (volume status)

Atrial septal defects (bubble study)

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SUPRASTERNAL VIEW

Structures Visualized

Aortic arch

Branch vessels

Common Pathologies

Aortic coarctation

Aortic dissection

Arch anomalies

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COMMON PATHOLOGICAL FINDINGS ACROSS VIEWS

Left Ventricular Systolic Dysfunction

Global hypokinesia

Reduced ejection fraction

Diastolic Dysfunction

Abnormal E/A ratio

Elevated E/e’

Left atrial enlargement

Valvular Heart Disease

Stenosis: thickened, restricted leaflets, high gradients

Regurgitation: color Doppler jet area, vena contracta

Pericardial Diseases

Effusion

Tamponade (RA/RV diastolic collapse)

Intracardiac Masses

Thrombus

Vegetations

Tumors (e.g., myxoma)

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CLINICAL PEARLS

Always interpret echo findings in multiple views

One pathology may be missed if only a single window is used

Correlate echo findings with ECG and clinical presentation

Optimize image quality before measurements

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CONCLUSION

Mastery of echocardiographic views allows accurate identification of structural heart disease, functional abnormalities, and hemodynamic disturbances. Understanding which pathology is best visualized in which view is the cornerstone of competent echocardiography practice.