QUARTERLY BEAT
OCTOBER 2026
This is what we call the “systematic approach to FCU.”
These three questions are an excellent starting place. As we journey through the world of FCU, these questions will become more focused and, when integrated into clinical context, will become more meaningful.
Isn’t it more logical to start with the left heart and then move on to the right?
I am glad you asked! In short, no.
Here is an example.
Figure 7b: The orientation marker on the screen corresponds with that on the probe; different manufacturers use different on-screen marker symbols. (Image courtesy of Dr. Christopher Kennedy, DACVECC, DECVECC) Sometimes structures in the sector can be muddled by the processing of the ultrasounds. Resolution is the ability to differentiate between two points in proximity. (See Figure 8) • Lateral resolution: the ability to differentiate between two things lying linearly side-by-side at the same depth. • Axial resolution: the ability to differentiate between two things along the same linear path as the ultrasound beam.
Video 5: Focusing on the left heart, the left ventricle is underloaded. This might prompt you to consider hypovolemia and fluid administration.
Video 6: When we consider first the right heart, it is clearly enlarged. This explains the underfilling of the left heart and identifies this patient as probably fluid intolerant—intravenous fluids will likely worsen this patient. Cases like this should be discussed with a cardiologist. Clinical integration The systematic approach to FCU is more developed than a quick peek at the heart. It involves several views, three general questions (see above) and encourages appraisal of all four heart chambers, their walls, the valves and the pericardium. Remember, we are not cardiologists, so we are not performing a formal echocardiogram. Goal #3 of FCU is to integrate this information into our clinical examination. What clinical questions were you asking? Sometimes these questions are simple—in my collapsed patient with poor pulses, is there pericardial effusion? Sometimes these questions are more complex— in my patient with respiratory distress, could there be a cardiac cause?
Figure 8: The blue dots are at the same depth and sufficient lateral resolution is required to resolve them. The pink dots are at different depths but lie along the same linear path as the ultrasound beam: sufficient axial resolution is required to resolve them. If the resolution is insufficient, these dots would blur into one blue and one pink structure. (Image courtesy of Dr. Christopher Kennedy, DACVECC, DECVECC) Three questions In each view, there are three questions to ask yourself and in this specific order: 1. Is there pericardial effusion?
2. How is the right heart?
3. How is the left heart?
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