Ultrasound imaging is a very versatile and fast medical imag-ing modality, however it can suffer from serious image quality degrada-tion. The origin of such loss of image quality is often difficult to identifyin detail, therefore it makes it difficult to design probes and tools thatare less impacted. The objective of this manuscript is to present an end-to-end simulation pipeline that makes it possible to generate syntheticultrasound images while controlling every step of the pipeline, from thesimulated cardiac function, to the torso anatomy, probe parameters, andreconstruction process. Such a pipeline enables to vary every parameterin order to quantitatively evaluate its impact on the final image quality.We present here first results on classical ultrasound phantoms and a dig-ital heart. The utility of this pipeline is exemplified with the impact ofribs on the resulting cardiac ultrasound image.