What techniques do you find most helpful to optimize image acquisition for cardiac POCUS in patients with poor acoustic windows?  

For the parasternal windows, your enemies are ribs and lungs. Regarding ribs: Whenever an image gets dark, people tend to try and crank up the gain knob to compensate. In many cases, however, it's usually because one of the edges of the probe is abutting a rib. Try and slide the probe a few millim...