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Cardiac Echocardiography Phillips Perera, MD, RDMS*, Viveta Lobo, MD, Sarah R. Williams, MD, Laleh Gharahbaghian, MD KEYWORDS Cardiac echocardiography Focused echocardiography Bedside echocardiography Cardiac ultrasound Pericardial effusion Cardiac tamponade Cardiac contractility Pulmonary embolism KEY POINTS Focused cardiac echocardiography has become a critical diagnostic tool for both the emergency physician and critical care physician caring for patients with chest pain, short- ness of breath, in a shock state or following trauma to the chest. Cardiac echocardiography allows for the immediate diagnosis of pericardial effusions and cardiac tamponade, the evaluation of cardiac contractility and volume status, and the detection of right ventricular strain that may be seen with a significant pulmonary embolus. Advanced echocardiography applications that utilize Doppler technology may be used for more advanced ultrasonographic examinations (cardiac valvular, hemodynamic evaluations). The emergent cardiac procedures, pericardiocentesis and placement of a transvenous pacemaker wire, can be performed more accurately and safely with ultrasound guidance. This article covers how to perform cardiac echocardiography using the standard win- dows, how to interpret a focused goal-directed examination, and how to apply this infor- mation clinically at the bedside. INTRODUCTION Cardiac echocardiography has evolved to become one of the most important clinical skills for both the emergency physician (EP) and the critical care physician (CCP). Current ultrasound technology contained in smaller and more portable units has dramatically improved in the recent past to allow for performance of focused echocar- diography in the relative safety of monitored clinical areas.1 Essential treatment of t