Page 4 : BASIC ECHO - BSE level one echo - This is an ideal protocol and is easily understandable and reproducible

 BSE level 1 Echocardiogram (modified to clinical indication and image acquisition) 

15 views 

Images from the following windows 

1) PLAX - Clip to show LV systolic function 

(The BSE protocol also suggests deeper view to view pleural effusion - however our protocol would finish by looking at lung lines and pleural effusions)

Use this view to measure or estimate EPSS (M mode of this optional) 

2)  PLAX still  with measurements (eg LVEDD/septum / Aortic root and RV  / LA diameter ) 

3,4) PLAX clip or still will colour through MV / AV   

5,6,7 ,8) PSAX clips at level of Aortic valve , MV , Papillary muscle and Apex (apex view not shown)

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(Demonstrate valves opening  and RWMA, “D” sign ) 

9,10,11,12 A4C)      clip and stills 

Views including straight forward 4 chamber view , 4 chamber with colour through MV and TV and TAPSE on m mode 

Good 4 chamber view with open LA (measure RV base) 

Colour though MV and TV 

MAPSE (optional) MV CW demonstrating diastolic filling ( also optional ) -

13,14 , 15) ) 2 clips : 2 X A5C view with Aortic valve with and without colour  and subcostal view 

 

( if you have a good CW Doppler tracing  , < 20 degree angle of insonation from Doppler direction , use this to estimate AV max velocity ) 

 

Clinical questions (Must be able to answer  1-4) 

1)LV systolic function estimation - EPSS / visual estimation / fractional shortening . 

Knows pit falls ( particularly valvular pathology / off axis measurements / RWA) 

2)Haemodynamic/volume  status - based on IVC and general signs of overfilled or under filled Left heart ( eg LV Esd , interatrial septal bowing ) -pitfalls 

3) RV systolic function ( size / septal flattening / TAPSe/ visual - McConnell sign) Pitfalls 

4) Pericardial effusion  - 3 signs of Tamponade 

5) Obvious valvular abnormality - pitfalls 

6) Signs of Diastolic dysfunction  - pitfalls 

7) LVOT VTE and significance in assessing volume responsiveness 

8) TR Vmax measurements - significance 

FORMATIVE / SUMMATIVE scan (“+/-“ means optional or additional NOT pass /fail ) 

1. Basics ( eg cleaning principles , depth , patient details , patient position , knowledge of technique and direction of probe )       Pass / fail  .  Feedback 
2. PLAX view . Saves appropriate clips / images . Anatomy knowledge , image acquisition technique , measurements and estimation of LV systolic function , obvious structural abnormality , pericardial effusion , (+/-obvious valvular abnormality ) Pass / fail . Feedback 
3. PSAX . Saves appropriate clips . Comments on D sign, systolic function , +/- RWMA ,+/- LV wall thickness , RV size ,+/- TAPSE , +/- mconells ,  Pass /fail feedback 
4. A4C . Image acquisition ( LA must be open , not foreshortened), saves appropriate clips , RV /LV ration +/-  measures RV base , +/- obvious RWMA , systolic dysfunction of either RV /LV , +/- TAPSE , +- MAPSE , colour through MV and TV , +/- MV CW for diastolic wave form , +/-  CW at TR for measurement of RV peak systolic pressure 
5. Apical 5 C visualisation of AV, saves clip or still  , colour through AV +/- Peak velocity through AV