To review a focused cardiac ultrasound clip, work in this order: name the view, check whether the image is adequate, describe the anatomy and motion, then state what remains uncertain. A familiar-looking image is a starting point for reasoning. It does not tell you everything about the heart or the patient.
This beginner lesson gives you a repeatable way to study an educational clip before your next supervised scanning session. You will use an actual POCUS Simulator recording, answer three questions and choose one skill to practise next.
What is focused cardiac ultrasound?
Focused cardiac ultrasound (FoCUS) is basic cardiac point-of-care ultrasound performed by a treating clinician to address a clinical question. The American Society of Echocardiography distinguishes it from advanced cardiac POCUS and from consultative echocardiography. A consultative examination may itself be comprehensive or limited; the distinction is more precise than “small scanner versus big scanner.” The operator’s training, examination scope, interpretation and documentation matter. ASE cardiac POCUS nomenclature, 2024.
FoCUS commonly includes parasternal long-axis, parasternal short-axis, apical four-chamber and subcostal views. A short app excerpt is only one part of that learning. This article teaches a clip-review habit; it is not a complete acquisition protocol or a competency assessment.
1. Name the view before naming a finding
Start by saying the view aloud. Then identify the structures that support your answer. Do not identify a chamber solely because it sits on one side of the screen: probe and display conventions must be understood together.
- Parasternal long-axis (PLAX): look for the left ventricle, mitral valve, left atrium and aortic root/outflow region; part of the right ventricle lies in the near field.
- Parasternal short-axis (PSAX): name the level. A slice through the aortic valve is different from a mid-ventricular slice through the papillary muscles.
- Apical four-chamber: orient yourself to the two atria, two ventricles, septa and atrioventricular valves.
- Subcostal four-chamber: recognise the alternative window and its relationship to the liver.
For acquisition instructions and labelled reference views, use the ACEP cardiac Sonoguide alongside supervised teaching.
2. Decide what this image can answer
Before accepting a label, pause for an image-quality check. Use these questions as a study prompt:
- What is the question? Write a specific task, such as identifying the LV cavity in the displayed PLAX example.
- What must be visible? Point to the required landmarks. If you cannot locate them confidently, record that uncertainty.
- What can I follow through time? Replay the cine and track the same structure. A single frame cannot show a whole contraction.
- What is missing? Name the additional view, better image or explanation that would help you answer responsibly.
These prompts organise your review; they are not a validated image-quality score. “I cannot judge this from the available clip” is a useful answer when you can explain why.
3. Compare normal and severely reduced LV function
Compare chamber anatomy and LV contraction in two PLAX examples. Watch the normal reference first, then the severe LV dysfunction reference.
First: normal LV systolic function. Use the normal reference to identify the LV cavity, mitral valve, left atrium and aortic root. Follow the LV walls through the cardiac cycle: look for inward motion, wall thickening and a smaller cavity during systole.
Next: severely reduced LV systolic function. Compare how much the LV walls move and how much the cavity changes. The second example demonstrates reduced contraction, with the app’s feedback identifying reduced LV wall motion.
This is a qualitative comparison of systolic function, the function reflected by ejection fraction. These excerpts do not provide a measured EF percentage or a full assessment of chamber dimensions.
What the recording shows
The first half comes from the Normal FoCUS pathology module; its feedback states “Normal systolic contraction.” The second comes from Severe LV Dysfunction. The original moving scans and feedback are preserved. They are separate teaching examples, not the same patient before and after treatment.
Recorded from POCUS Simulator, the iOS app. Released features and access may differ.
4. Describe a finding without overreaching
Try this sentence pattern in your learning notes:
“In this [view], I can identify [structure]. I observe [specific feature or motion]. I cannot determine [remaining question] from this excerpt. My next step is [review task or supervisor question].”
For example: “In this PLAX reference, I can identify the LV cavity, mitral valve and left atrium. The LV walls show reduced inward motion and the cavity changes little during systole, supporting reduced LV systolic function. I would compare additional views before making a complete assessment.”
A visible contraction does not establish that all cardiac function is normal. Preserved systolic function does not exclude heart failure, and a focused clip cannot rule out pulmonary embolism. ACEP also stresses that tamponade requires clinical context. ACEP cardiac pitfalls.
Check your reasoning before moving on
Answer each question first, then open the explanation. These are reflection prompts, not a clinical assessment.
What should I compare between normal and severely reduced LV contraction?
Track inward wall motion, systolic wall thickening and the change in LV cavity size through several beats. Normal contraction produces a clearer reduction in cavity size; severely reduced contraction shows less motion and less cavity change. Use the whole moving sequence, then check other views and image quality.
How does this relate to ejection fraction?
Normal and severely reduced systolic function are qualitative categories. This exercise teaches recognition of contraction; it does not supply a calculated EF percentage. A complete assessment combines adequate views, clinical context and appropriate measurements.
What should I do when I cannot confidently identify the view?
Return to a labelled reference, name the landmarks you recognise, and identify the missing cue. Bring that specific question to a qualified supervisor. Repeating a guess until it matches a label does not explain the image.
Make the next practice session specific
Choose one different approved clip. Write the view, two landmarks and one limitation before revealing its explanation. Compare your reasoning with the reference, then record one correction in the POCUS practice log.
For your next supervised scanning session, ask for feedback on one physical skill you cannot practise from a recording, such as obtaining and maintaining an adequate view. Keep clip recognition and hands-on performance as separate learning goals.
Explore more recorded POCUS Simulator activities, revisit probe orientation and movements, or find ultrasound education events.
Sources and further study
- American Society of Echocardiography. Recommendations for Cardiac Point-of-Care Ultrasound Nomenclature. 2024. Definitions and examination scope.
- American College of Emergency Physicians. Sonoguide: Echocardiography for Emergency Physicians. Reference views, acquisition teaching and interpretation pitfalls.
