The parasternal long axis view is obtained by placing the transducer in the intercostal space III-IV to the left of the sternum

The orientation marker (OM) on the transducer should be directed towards the patients right shoulder. This is the only view where the OM is directed towards the right side of the patient

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

Imagine that the probe is placed on the upper border of the screen with the red and the blue radii diverging from the probe

The red radius of the sector presented on the screen corresponds to the red radius of the yellow sector intersecting the heart of the torso

The blue radius of the sector presented on the screen corresponds to the blue radius of the yellow sector intersecting the heart of the torso

The apex of the heart is displayed on the left side of the screen

Notice that the green arrow points towards the patient’s right shoulder in this particular view

The target view is a 3-chamber and ascending aorta image

The position 3 PLAX view is shown on page 1 of the FATE card. It corresponds to the yellow scanning plane illustrated on the torso of the figure

The RV is located anteriorly, directly under the transducer and appears in the near field

The left ventricle and the left atrium are located deeper and appear in the far field with the ascending aorta interposed between the left atrium and right ventricle

Notice that the apex appears on the left side of the screen, and the LA and ascending aorta appear on the right side

The structures identified in the FATE position 3, parasternal long axis view are:

– RV: Right ventricle
– AO: Ascending aorta
– LV: Left ventricle
– LA: Left atrium
– PW: posterior wall
– pericardium
– AML: Anterior mitral leaflet
– PML: Posterior mitral leaflet
– IVS: Inter-ventricular septum
– Descending thoracic aorta

Notice that the apex of the heart is generally not seen in this view (outside the sector to the left of the screen)

The two parasternal views are approximately perpendicular to each other

The parasternal long axis (PLAX) view cuts the heart from base to apex

The parasternal short axis (PSAX) view cuts the heart across both ventricles at the mid-papillary level

In the following we will go through the positions in detail, focusing on how to obtain the right 2D ultrasound image, and how to interpret the image

First we will go through the PLAX view, and then the PSAX view

Left lateral position – approx. 45 degrees – is generally the optimal position for the apical 4 chamber view

The apical 4 chamber view is perfect for evaluation of pericardial effusion, pulmonary embolus and global function of both the right and the left ventricle. The pathology will be explained later

The image will often improve with expiration

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

Position 3 is indicated on the FATE torso in the lower right corner of the card

The images in the middle of page 1 are the target images to be obtained in position 3

Study the FATE card and memorize position 3 and the target image to look for before beginning the examination

You can get the FATE card in Google Play or the AppStore

In most patients the ictus cordis is palpable, and in some it is visible

The ictus is a good starting point for obtaining the apical 4 chamber view

The video shows a person with a visible ictus cordis

The FATE position 3 is called the parasternal view

Two different views are obtained in the FATE position 3. They are named:
– The parasternal long axis view (PLAX) and
– The parasternal short axis view (PSAX)

The positions are obtained in position 3 of the FATE card

The parasternal views are suitable for a quick qualitative evaluation of:
– Pathology (pericardial effusion, pulmonary embolus)
– Wall thickness
– Chamber dimensions
– Bi-ventricular function

You will now be taken through these two positions in detail, focusing on how to obtain and interpret the right 2D ultrasound image