Step 1 – PLAX

Start with deep image to assess for effusion before optimising depth

Colour doppler AV & MV – overall view and zoomed.

M-mode through AV & MV – if correctly aligned.

LV measurements.

Zoom into AV:

  • Measure LVOT with AV open
  • Cusps, sinus, ST junction, prox ascending aorta – with AV closed.
  • Repeat colour.

Zoom into MV. Repeat colour.

Step 2 – Tilted PLAX – anteriorly to RV outflow view

Colour doppler thorugh PV.

PW in RVOT – can measure RVOT Vmax.

CW – PV to assess for valvular pathology. Measure PV Vmax.

Step 3 – Tilted PLAX – posteriorly for RV inflow view

Best view for visualising tricuspid.

Colour doppler TV..

CW for valvular pathology.

Step 4 – PSAX

Best view for visualising RWMAs.

Start with base – assess TV if good view. Colour + CW.

PV + modified view for MPA/bifurcation.

  • Measure RVOT
  • Colour + CW
  • PW – measure RVOT Vmax
  • CW – measure PV Vmax.

Interatrial septum – colour to assess for defect..

AV at base – visual inspection for leaflets. Zoom + colour for AR.

Fan towards apex – to level of MV and zoom/colour.

Papillary muscles – M mode + measurements if needed. Visual assessment for RWMAs.

Fan to apex.

Step 5 – A4C – LV/LA

Visual assessment.

Colour over MV

PW – for E/A/dec time.

CW for valve pathology. Zoom into MV – repeat colour.

M-mode – MAPSE.

TDI – lat + septum – e’/a’/s’

Simpson’s/LV length

LA volume.

Step 6 – A4C – RV + RA

Visual assessment

Colour over TV.

CW for valve pathology.

Zoom + colour.

M-mode – TAPSE.

TDI – lat wall – RVS’.

Zoom into RA:

  • Measure RA area.
  • RA height(major axis)/width(minor axis).
  • RV width at base/mid.

Colour over atrial septum.

Step 7 – A5C

Colour to include all of LV.

CW at leaflet tips – AV Vmax/VTI

PW in LVOT – LVOT Vmax/VTI

Step 8 – A2C

Visual assessment.

Simpson’s.

Colour/CW if req.

Measure LA volume.

Step 9 – A3C

Visual assessment for RWMAs.

Colour doppler.

Can repeat measurements for MV and AV – particularly in AS to increase accuracy.

Step 10 – Subcostal

Visual assessment.

Colour over atrial and ventricular septum.

Best view for identifying defects.

Measure width of RV free wall.

Step 11 – IVC

Visual assessment.

M-mode + sniff test for collapse if not ventilated.

Step 12 – Suprastenal notch

Measure arch + descending aorta.

PW in descending aorta.

Can use m-mode with colour if suspicion of dissection/reverse flow.