Transthoracic echocardiography (TTE) is the most common type of cardiac echocardiography exam. The examination can be performed on a cooperative, awake patient, but the images are complicated by patient size, bone, soft tissue, and lung tissue interactions. As a result, the ultrasound beams from the transducer head must be aimed through “acoustic windows” in the thorax to image the heart. There are four typical acoustic windows; the parasternal, apical, subcostal, and suprasternal notch (Figure 1). The parasternal window is typically used for 2 chamber, long-axis views and short axis views of the heart. The apical window is typically used for the standard 4 chamber, long-axis view. The subcostal window is particularly useful for patients with lung disease or recent open-heart surgery and provides good views of major vascular connections to the heart and the interatrial septum. The suprasternal window is valuable for aortic root imaging.
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