1. Hudson Valley Community College Echocardiography Protocol Sarah Burns Kristin Logan Valerie Burdo Kathy Ives Jennifer Mesch John Coram Ali

2. The Echo exam will provide information to assess, measure, and document overall cardiac Function. http://www.stanthonys.org.uk/news.html

3. Equipment to be Checked prior to exam Proper Transducer Examination Table ECG wires and electrodes Storage Documentation (VCR Tape) Transducer gel Patient gown Sheets

4. Equipment (continued) Towels Disinfectant spray

5. Prior to the Examination Obtain patient consent Obtain patient’s medical history Insure there is a valid signed and dated Physician’s order Note the indication for the exam (If applicable) Review any previous exams Enter the patient identification

6. Patient Preparation Advise patient to remove clothing from the waist up and to change into a hospital gown Have patient lie supine Attach ECG electrodes to the chest Have patient now lie in left lateral decubitus position with left arm elevated Dim the lights

7. The Exam www.aimshospital.org/Pages/PedCard/ noninvasive.html

8. Parasternal Long Axis 4-5 inter-costal spaces Index toward right shoulder Assess for wall motion Asses size and function of RV, LV, IVS, LVPW, LVOT, LA, MV, and products.medison.co.kr/category/.../ sm-3.asp

9. Parasternal Long Axis Color Flow Doppler Aortic Valve Mitral Valve www.vmth.ucdavis.edu/cardio/cases/ case11/color.htm

10. Measurements (2-D or M-Mode) Aortic Root Left atrium Left Ventricle Inter-ventricular Septum LV posterior wall www.s2.chalmers.se/research/image/ Research/iag_projects.html

11. Parasternal- RVIT Angle inferiorly towards Patients right hip Color flow Doppler of TV Pulsed Wave Doppler TV

12. Parasternal Short Axis Aortic Level -document tri-leaflet -tricuspid valve -pulmonic valve -color flow Doppler -Pulsed Wave Doppler -M-mode (if app.) Mitral Valve Level -left ventricle wall motion -M-mode (if app.) -valvular motion

13. Parsternal Short (cont) Papillary -note LV wall motion Apex -note LV wall motion info.med.yale.edu/intmed/cardio/ imaging/techniques/echo_intro

14. Apical Views

15. Apical Location Find the Apical Impulse on lower left side of chest Place the index toward the patients left side www.cardiology-houston.com/ Diagnostics/diagnostics.html

16. Apical 4 LV wall motion Spectral recording of MV Spectral recording of TV Pulse wave Doppler of MV & TV Continuous wave Doppler if necessary Color flow Doppler of MV & TV

17. Apical 5 Chamber Interrogate LVOT Pulse wave Doppler of LVOT & AoV Continuous wave Doppler (if appl.) Color flow Doppler www.fvet.uba.ar/hospital/ecocardio/ ecocanino.htm

18. Apical 3 Chamber Document LV wall motion Color flow Doppler to MV, AoV, and LVOT Pulsed wave Doppler to interrogate Aov www.ctr.columbia.edu/~shahram/ research_echo.htm

19. Apical 2 Chamber Document LV wall motion Apply Color Flow to interrogate MV

20. Sub-Costal Views

21. Sub-costal Location Have patient lie on back with knees elevated Place transducer below the xyphoid process Angle the transducer to the patients left should with index toward the left side of the body

22. Sub-costal Sub-costal Long -document 4 chambers -color flow Doppler to assess IAS and IVS IVC, Hepatic veins, and abdominal aorta Sub-costal Short -Aortic level -Mitral -Papillary -Apex

23. Supra-Sternal Patient in supine position Extend neck Angle inferiorly toward the heart Assess ascending and descending aorta Color Flow Doppler Pulse wave Doppler www.quintemri.com/ casestudies_AorticArch.html