– Optimal patient position: supine or sitting; image improves in 50% with partial inspiration

– Hold the transducer as a screw driver prone with your right hand

– Place the transducer subcostally, slightly on the right side of the abdomen

– OM should be directed towards the patient’s left

– To achieve correct anatomical alignment rotate the transducer approx. 20

In this video the anatomical structures are indicated on the beating heart

Observe: Liver, apex of the heart, base of the heart, right atrium, right ventricle, left atrium, left ventricle, inter-ventricular septum, inter-atrial septum.

You have now been introduced to the basic FATE positions and views and the FATE card

Four different positions, or “windows”, on the thorax are included in a full basic FATE examination

From these positions 6 imaging views can be achieved:
– Position 1: Subcostal 4-chamber view (S4CH), C in the image
– Position 2: Apical 4-chamber view (A4CH), D in the image
– Position 3: The parasternal long-axis view (PLAX), A in the image
– Position 3: The parasternal short-axis view (PSAX), B in the image
– Position 4: Pleural windows – 2 views, right pleura and left pleura, not shown in the image

In the following lessons a systematic and comprehensive review of the individual views will be given

The subcostal view is obtained by placing the transducer in the subcostal position, slightly to the right of the midline

The orientation marker on the transducer should be directed towards the patient’s left

Notice the location of the heart in the thoracic cavity and the orientation of the ultrasound sector beam (the scanning plane)

Page 1 on the FATE card is used for this part of the FATE examination

Position 1 is indicated on the FATE torso in the lower right corner of the card

The image in the upper left corner of page 1 of the FATE card is the target image to be obtained in position 1

Study the FATE card and memorise position 1 and the target image before beginning the examination

You can download the FATE card from: usabcd.org/FATE-card

The FATE position 1 is called the subcostal or subxiphoid view

The subcostal view is a 4 chamber view, imaging all 4 chambers of the heart

The position obtained in position 1 is indicated on page 1 of the FATE card

The subcostal 4 chamber view is suitable for a quick qualitative evaluation of:
– Pathology (pericardial effusion, pulmonary embolus)
– Wall thickness
– Chamber dimensions
– Bi-ventricular function

This lesson will go through the position in detail, focusing on how to obtain and interpret the right 2D ultrasound image

The inferior vena cava (IVC) is also found in this lesson

The parasternal short axis view (PSAX) is obtained from position 3 by aiming the orientation marker on the transducer at the patient’s left shoulder

In this view two cardiac chambers can be visualized:
– Left ventricle (LV)
– Right ventricle (RV)

The parasternal long axis view (PLAX) shows how the image should appear by convention on the screen

Observe the base of the heart at the right side of the screen, and the apex of the heart at the left side of the screen – in contrast to the subcostal 4-chamber view

In this view the aortic (AO) and mitral valves (MV) can be evaluated

The parasternal long axis view is suitable for a quick evaluation of:
– Pathology
– Wall thickness (M-mode)
– Chamber dimensions (M-mode)
– Mitral septal separation (M-mode)
– Aortic and mitral valves

The parasternal short axis view (PSAX) shows how the image should appear by convention on the screen

This view is suitable for a quick evaluation of:
– Pathology
– Dimensions of cavities: Left and right ventricle
– Myocardium: Left and right ventricle
– Left ventricular function:
– Global
– Regional (Myocardium with blood supply from all three coronary arteries represented)

The pleural views are obtained from position 4

As part of the FATE examination these structures should be visualised:
– Liver (right side)
– Spleen (left side)
– Diaphragm (both sides)