Clinical question How is my patient’s left heart pumping?
Patient positioning Supine or Semi-recumbent (30–45°): Optimal for ICU or ED patients.
Left lateral decubitus: Preferred in stable patients to optimize imaging windows.
Head of bed may be elevated slightly to improve visualization in dyspneic patients.
Supplies needed No special supplies needed
Probe Phased Array Transducer
Frequency: 1–5 MHz
Small footprint allows access between ribs
Optimized for deep penetration needed to visualize cardiac structures
Normal findings Symmetric LV wall motion with inward thickening
LV cavity visibly reduces in size during systole (≥50%)
No regional wall motion abnormalities
Normal EF ≈ 52–74% depending on gender (chart provided below)
Sensitivity & specificity Visual (eyeball) EF:
Sensitivity: ~80–90% for detecting reduced EF
Specificity: ~85–95%
Contraindications None
Alternate diagnostic modalities Formal transthoracic echo (TTE): Gold standard
Transesophageal echo (TEE): Best in intubated/poor-window patients
Cardiac MRI: Gold standard for volumetric EF
Nuclear scans (MUGA): Rarely used

How to perform this exam

1. Prepare supplies (ultrasound machine, gel, chuck)

2. Position the patient

3. Select the probe & preset

4. Parasternal Long Axis (PLAX) view

5. Parasternal Short Axis (PSAX) view

6. Apical 4-Chamber (A4C) view