What are the standard views included in a 2D (two-dimensional) echocardiogram?

Standard Views in a 2D Echocardiogram

A standard two-dimensional (2D) echocardiogram includes multiple views acquired from the parasternal, apical, subcostal, and suprasternal transducer positions to provide comprehensive assessment of cardiac structures and function. 1

Parasternal Views

• Parasternal Long-Axis (PLAX): Shows left ventricle, left atrium, aortic root, and mitral valve in a longitudinal plane 1
• Parasternal Short-Axis (PSAX): Multiple levels are obtained by tilting the transducer from base to apex 2:
  • Aortic valve level: Shows aortic valve, right ventricular outflow tract, and left atrium 2
  • Mitral valve level: Displays mitral valve leaflets in cross-section 2
  • Papillary muscle level: Shows left ventricular walls and papillary muscles 2
  • Apical level: Displays the apex of the left ventricle 2

Apical Views

• Apical Four-Chamber (A4C): Shows all four cardiac chambers, mitral and tricuspid valves 2
• Apical Two-Chamber (A2C): Shows left atrium and left ventricle 2
• Apical Three-Chamber (A3C)/Long-Axis: Shows left ventricle, left atrium, aortic valve and proximal ascending aorta 2
• Apical Five-Chamber: Modified four-chamber view that includes the aortic valve and proximal ascending aorta 1

Subcostal Views

• Subcostal Four-Chamber: Alternative view of all four chambers, especially useful when parasternal and apical windows are limited 1
• Subcostal Short-Axis: Shows the pericardium and right ventricular free wall 1
• Inferior Vena Cava (IVC) View: Assesses IVC size and respiratory variation 1

Suprasternal Views

• Suprasternal Notch View: Shows the aortic arch and proximal great vessels 1

Imaging Planes and Orientation

• Standard imaging uses three primary planes 2:
  • Transverse plane: Horizontal plane perpendicular to the long axis of the body, dividing the heart into superior and inferior segments 2
  • Sagittal plane: Vertical plane dividing the heart into right and left segments 2
  • Coronal plane: Vertical plane dividing the heart into anterior and posterior segments 2

Clinical Applications

• These standardized views allow for comprehensive assessment of 1:
  • Cardiac chamber size and function
  • Valvular morphology and function
  • Regional wall motion abnormalities
  • Pericardial effusion
  • Intracardiac masses or structural abnormalities

Technical Considerations

• Standard display conventions orient images with the cardiac apex at the bottom of the screen and the base at the top 3
• The right side of the heart is conventionally displayed on the left side of the screen in most views 3
• Each view should be optimized for depth, gain, and focus to ensure adequate visualization of relevant structures 1

Common Pitfalls

• Foreshortened views can lead to underestimation of chamber volumes and inaccurate assessment of function 4
• Patient factors such as body habitus, lung disease, or chest wall abnormalities may limit acoustic windows 1
• Proper transducer positioning is critical to obtain standardized views and avoid off-axis imaging 3

By following these standardized views, clinicians can ensure comprehensive assessment of cardiac structure and function, which is essential for accurate diagnosis and clinical decision-making.