One card per view — probe position, machine setup, the acquisition steps, what confirms the view before you record, and the pitfalls. Taken step-for-step from the EASy MAP methods paper. Free to print and laminate for your own machines — no sign-up.
Set your printer to Letter, landscape and background graphics on. One card per sheet — trim and laminate for the machine.
1
Subcostal 4-Chamber
View 1 · probe position A · the cardiac window
EASy MAP
Machine setup
Sector (phased-array / cardiac) probe — the same probe for all six views.
Adult Cardiac preset, B-mode.
Marker indicator on the upper right of the screen (cardiology convention).
Depth 21 cm.
Frequency at the probe's lowest setting (typically 2 MHz).
TGC on; increase far gain to fill in the far field.
Acquire
Gel the transducer. Patient supine if tolerated and practical.
Place the probe 2 cm inferior to the xiphoid process, marker toward the patient's left (3 o'clock), overhand grip.
Trap a small skin fold under the probe; significant inward pressure is often needed. Attend to comfort in awake or lightly sedated patients.
Angle the probe tail caudally and toward the patient's right, coming slightly out of the axial plane — this aims the beam cephalad and toward the patient's left.
A segment of liver should appear in the superficial image: the left lobe is the acoustic window that carries the beam to the heart.
Pitfalls
Not enough gel, or not enough probe pressure — the commonest cause of a poor novice image.
Gripping the probe too far from the emitter, or too tightly, kills fine control.
Subcostal alone can underestimate RV size and miss the cardiac midsegment and apex.
In very low-flow states or on mechanical support, swirling heterogeneous echogenicity in the ventricles is stasis, not a gain problem.
A poor-quality cardiac view (≤ 6) is not usable for cardiac decisions — the IVC, lung and pleural findings may still be actionable.
Optimize
At 21 cm the sector should already extend slightly beyond the posterior LV wall, so the whole pericardium is included — if the heart still doesn't fit, add depth.
Set gain so blood filling the chambers is black; some visible turbulent flow is acceptable.
Off-axis chambers → rotate counterclockwise. Chambers cut off or off-centre → rock right or left.
LVOT in view → you are in a 5-chamber plane; lift the tail to drop it out.
Confirm before you record
A correctly acquired view shows both ventricles, both atria, and the tricuspid and mitral valves — but not the left ventricular outflow tract. Record a 4 s clip (longer if the ventricular rate is < 30 bpm).
Read it in this order
Pericardium — non-trivial effusion (> 10 mm, through systole and diastole). Tamponade is a clinical diagnosis, supported by atrial collapse in systole or ventricular collapse in diastole.
RV size and function — an RV larger than the LV (RV/LV > 1) is severe dilation; look for a diastolic free wall > 1 cm or an enlarged RA as signs of chronicity.
Septum — thinning, rupture, hypertrophy; shift toward the LV if the RV is dilated.
LV size and function — severe dilation, marked wall thickening, or minimal systolic cavity reduction with poor mitral annular motion.
Then integrate with the IVC, the lung profile and the clinical picture — not before.
12-point quality score
Score each 0–2
Total
Pericardium · RV size · RV function
10–12 good
Septum · LV size · LV function
7–9 adequate
0 = not assessable, 1 = usable, 2 = clear
≤ 6 poor
2
Subcostal IVC
View 2 · probe position B · venous return
EASy MAP
Machine setup
Sector (phased-array / cardiac) probe — the same probe for all six views.
Adult Cardiac preset, B-mode.
Marker indicator on the upper right of the screen (cardiology convention).
Depth 21 cm.
Frequency at the probe's lowest setting (typically 2 MHz).
TGC on; increase far gain to fill in the far field.
Acquire
Remove the probe entirely from the subcostal area, then rotate the marker cephalad (12 o'clock).
Replace it at the same location used for the cardiac view, in the new orientation.
Angle the beam slightly toward the patient's left (tail toward the patient's right) to find the aorta.
The IVC sits within the liver, just to the patient's right of the aorta.
Watch the vessel through the respiratory cycle and call it qualitatively — flat, normal size with respiratory variation, or plethoric. EASy does not measure the IVC.
Record a 4 s clip of the IVC, then a 4 s clip of the aorta.
Pitfalls
Aorta and IVC look alike side by side — identify both, or you will read the aorta as a non-collapsing IVC.
A flat IVC is not automatically an empty patient — external compression flattens it too. Raised intra-abdominal pressure (abdominal compartment syndrome, gravid uterus, laparoscopic insufflation) is obstructive physiology wearing a hypovolemic mask.
The hepatic vein draining into the IVC is an alternative landmark, but positive aortic identification works in essentially all patients.
Interpret the IVC with caution when the patient is not supine.
Obstructive causes of shock change IVC size and variation regardless of intravascular volume.
Why lift the probe off
Coming off the skin entirely before rotating prevents mistaking the right hepatic vein for the IVC. Either an underhand or overhand grip works for this view.
Read it — three states, no numbers
What you see
What it means
Flat
Poor venous return — or external compression
Normal size, varies with respiration
Neither flat nor plethoric
Plethoric
Poor forward flow
Optional add-ons from here
Rock the tail inferiorly from the aorta → aortic valve.
Rock inferiorly and tilt toward the patient's right, rotating toward the left shoulder → midpapillary short axis.
Rock the tail cephalad from the aorta → gastric antrum, if fasting status matters.
What this view adds
Venous return and filling pressure. Read with the heart, the IVC says whether the picture is under-filled or congested — and how much fluid the patient will tolerate.
3
Right Upper Lung
View 3 · probe position C · 2nd ICS, right midclavicular line
EASy MAP
Machine setup
Same sector probe, carried over from the subcostal views.
Adult Cardiac preset, B-mode, marker upper right.
Depth stays at 21 cm — the same depth for all six views.
If image quality is poor, switch to the Adult Lung preset and re-optimize.
Gain set so the airspaces of the lung parenchyma appear black.
Acquire
Come off the subcostal position, wipe excess gel from the abdomen, and re-gel the probe.
Place the probe in the 2nd intercostal space at the right midclavicular line, marker at 12 o'clock.
Apply gentle pressure and/or slide the probe vertically to get out from under rib shadows.
Tilt the tail slightly laterally so the beam meets the pleura perpendicularly, allowing for the curve of the chest wall.
Set gain so the lung airspaces are black; record once you have a clean interspace.
Pitfalls
Rib shadowing read as pathology — slide or angle, don't guess.
Too little pressure at the interspace: the pleural line blurs and sliding becomes unreadable.
Calling B-lines off a single interspace — check the mirror view on the left before you commit.
Reading the lung before the IVC and heart are done invites premature closure; finish all six views first.
Why the tilt matters
The pleura is a specular reflector — it only returns a clean signal when the beam strikes it square. If you see neither A-lines nor B-lines, the probe-to-pleura angle is off. Recheck orientation and angle before calling the image.
Read it
A-lines — dry lung; volume is tolerated.
B-lines — wet lung; the ceiling on volume.
Lung sliding — shimmering, to-and-fro motion at the pleural line with respiration.
Neither A- nor B-lines — a technique problem, not a finding. Re-optimize.
If you switch presets
Moving from a cardiac to a lung preset moves the marker indicator to the left of the screen and reverses image orientation. Re-orient before you read the image.
What this view adds
The ceiling on volume. A-lines say the lung is dry and will tolerate fluid; B-lines say it will not. This is the finding that turns a filling decision from a guess into a call.
4
Left Upper Lung
View 4 · probe position D · 2nd ICS, left midclavicular line
EASy MAP
Machine setup
Same sector probe, carried over from the subcostal views.
Adult Cardiac preset, B-mode, marker upper right.
Depth stays at 21 cm — the same depth for all six views.
If image quality is poor, switch to the Adult Lung preset and re-optimize.
Gain set so the airspaces of the lung parenchyma appear black.
Acquire
Move across to the 2nd intercostal space at the left midclavicular line, marker at 12 o'clock.
Apply gentle pressure and/or slide vertically to minimize rib shadowing.
Tilt the tail slightly laterally to keep the beam perpendicular to the pleura.
Set gain so the airspaces are black, then record a clip.
Pitfalls
Sliding off the midclavicular line and imaging over the heart instead of lung.
Rib shadowing mistaken for absent sliding.
Comparing the two sides at different gains — depth is fixed at 21 cm, so match the gain before you call asymmetry.
Stopping here: the pleural views still change the picture.
Read the pair together
The anterior upper lungs are read as a pair. Bilateral A-lines support a dry, fluid-tolerant picture; bilateral B-lines mark the ceiling on volume. A unilateral profile points at a focal process, not at volume state.
Read it
A-lines vs B-lines, and whether the profile is symmetric.
Lung sliding at the pleural line.
Neither A- nor B-lines — suboptimal probe-to-pleura angle; re-optimize.
If you switch presets
Moving from a cardiac to a lung preset moves the marker indicator to the left of the screen and reverses image orientation. Re-orient before you read the image.
What this view adds
Symmetry. With view 3 it settles fluid tolerance for the whole patient — and a one-sided profile redirects you to a focal process rather than a volume problem.
5
Right Pleural
View 5 · probe position E · right midaxillary line
EASy MAP
Machine setup
Same sector probe; wipe excess gel off the chest wall and re-gel.
Adult Cardiac preset, B-mode, marker upper right.
Depth stays at 21 cm — the same depth for all six views; it carries the spine onto the bottom of the screen.
Gain set so the hepatic parenchyma is mid-grey and the diaphragm reads bright.
Acquire
Place the probe at the right midaxillary line, in the same horizontal plane as the subxiphoid cardiac view, marker at 12 o'clock (superiorly).
Identify the liver, then angle the beam cephalad to bring in the diaphragm — a curved hyperechoic band immediately cephalad to the liver.
If beam transmission is poor, slide more posteriorly to image through more hepatic parenchyma.
Angle the tail anteriorly to bring in the anterior surface of the spine at the bottom of the screen — a hyperechoic line with shadow beyond it.
Identify the lung: it sweeps a large acoustic shadow across the screen with inspiration.
Pitfalls
Stopping at the diaphragm — without the spine in view you cannot call the spine sign.
Imaging too anteriorly and losing the hepatic window; go posterior instead of pressing harder.
Mistaking the mirror-image artifact above the diaphragm for effusion — fluid sits above the diaphragm and abolishes the curtain.
Dropping the depth below 21 cm and losing the spine off the bottom of the screen.
Confirm before you record
Liver, diaphragm, spine and lung must all be in view simultaneously. Record the clip only once you have all four in one frame — anything less will not answer the effusion question.
Read it
Pleural effusion or other pleural fluid (hemothorax in trauma) — note any loculations.
Consolidation directly: hyperechoic patchiness within the parenchyma.
Consolidation indirectly: the spine sign, or loss of the airspace curtain.
A large effusion or hemothorax is an obstructive contributor — read it against the IVC.
What this view adds
The obstructive and structural contributors — hemothorax, a large effusion, consolidation. With a plethoric IVC, this is where you look before you call the shock cardiogenic.
6
Left Pleural
View 6 · probe position F · left posterior axillary line
EASy MAP
Machine setup
Same sector probe; wipe excess gel off the chest wall and re-gel.
Adult Cardiac preset, B-mode, marker upper right.
Depth stays at 21 cm — the same depth for all six views; it carries the spine onto the bottom of the screen.
Gain set so the splenic parenchyma is mid-grey and the diaphragm reads bright.
Acquire
Place the probe at the left posterior axillary line, in the same horizontal plane as the subcostal cardiac view, marker at 12 o'clock.
Identify the spleen. If gastric air or anatomy obscures it, slide posteriorly as far as the table and chest wall allow and find the left kidney, which generally lies inferior to the spleen.
Identify the left hemidiaphragm superior to the spleen — a bright hyperechoic line, as on the right.
Angle the tail anteriorly to bring in the spine, then identify the lung sweeping its shadow with inspiration.
Pitfalls
Gastric air read as consolidation — reposition posteriorly and re-identify the spleen.
Staying too anterior: the splenic window is higher and more posterior than the hepatic one.
Pressing harder instead of moving posteriorly when the window is poor.
Calling the exam done before all six views are recorded; the last view still changes the presumptive diagnosis.
Confirm before you record
Spleen, diaphragm, spine and lung all in view simultaneously, then record. The splenic window is smaller than the hepatic one — expect to work harder for it, and go posterior rather than pressing harder.
Read it
Pleural effusion or hemothorax — note loculations.
Consolidation, directly or via the spine sign / lost airspace curtain.
Compare with the right: a unilateral effusion changes the differential.
What this view adds
The last piece of the sweep. Read all six together — heart, IVC, lung, pleura — to name the predominant physiology, then treat that one driver and reassess.
Content from Howell-Clark J, Bronshteyn YS, Pustavoitau A, Convissar DL, Bughrara N. Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients. J Vis Exp. 2025;(218):e67531. For educational use.