QUARTERLY BEAT
OCTOBER 2026
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FOCUSED CARDIAC ULTRASOUND (FCU) EXAMINATION
What is Focused Cardiac Ultrasound? Focused Cardiac Ultrasound (FCU) is ultrasound of the heart and major vessels, and can be very helpful in identifying the pericardium, pericardial sac and the right and left heart. There is no formal definition: we use it as cardiac ultrasound performed in non-cardiology settings to answer specific questions about cardiac structure and sometimes function. It is not a complete echocardiogram; it typically involves only 2D and M-mode cardiac imaging; Doppler echocardiography is part of critical care echocardiography (CCE), which is more advanced. What are the goals of FCU? 1. To visualize the pericardium/pericardial space, the right and the left heart from several angles. What can a focused cardiac ultrasound tell you at the bedside, and just as importantly, what can it miss? In this VETgirl article, Dr. Christopher Kennedy, DACVECC, DECVECC, walks through the core views of focused cardiac ultrasound (FCU), how to orient yourself to the image, and a systematic approach to evaluating the pericardium, right heart, and left heart. Read on to learn how to use FCU to identify overt cardiac abnormalities, avoid tunnel vision, and integrate your ultrasound findings with the rest of the clinical picture. Dr. Christopher Kennedy , DACVECC, DECVECC Clinical Assistant Professor, University of Illinois College of Veterinary Medicine
Video 1: PLAX4
Figure 1: PLAX4 view. LA, left atrium, RA, right atrium, LV, left ventricle, RV, right ventricle, IVS, interventricular septum. The pericardium is seen as a hyper-echoic, bright white line distal to the LV free wall. (Image courtesy of Dr. Christopher Kennedy, DACVECC, DECVECC)
2. Parasternal short-axis view at the level of the papillary muscles (PSAX-pap).
2. To identify overt abnormalities.
Often called the “mushroom view,” this view is useful; however, it should not be obtained first, as it does not provide the same overview of the heart as the PLAX4, which means you might hyperfocus and miss something important! (See Video 2).
3. To integrate this information with history and clinical examination.
FCU is not the same as a formal echocardiogram performed by a cardiologist. Like other point of care ultrasound categories, it is designed to be quickly implemented and answer targeted questions. As such, we are often looking for obvious, as opposed to subtle, abnormalities. A clever FCU practitioner uses it to complement their clinical examination and not as their only diagnostic tool. The views We teach FCU exclusively from the right side. It can be performed in lateral or sternal recumbency or standing. Cardiologists use phased-array probes; Microconvex (curvilinear) probes can also be used. 1. Parasternal long-axis 4 chamber view (PLAX4). This view is your landing view; always start your examination here. It captures most of the heart—four chambers, right and left, and the pericardium—in one view. It can provide bountiful information, so work on obtaining this view first. (See Video 1).
Video 2: PSAX-pap
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