Evaluation of the systolic cardiac function with ultrasound is performed by assessing:
– Endocardial (and/or myocardial) movement, during systole
– Myocardial thickening during systole
The video shows a PSAX view of a heart with normal LV function
Notice symmetrical endocardial movement towards the center of the LV and equivalent global and systolic myocardial thickening
This lesson will give an overview of the simplest assessment of the right and left ventricular function based on greyscale imaging (2D and M-mode)
First the systolic and diastolic ventricular function is covered
Next we will look at the ventricles individually
The following terms will be explained:
– Ejection fraction (EF)
– Eyeballing
– Fractional shortening (FS)
– Mitral septal separation (MSS)
– MAPSE = Mitral Annular Plane Systolic Excursion (LV)
– TAPSE = Tricuspid Annular Plane Systolic Excursion (RV)
– Myocardial and cardiac chamber dimensions
Structures identified in the FATE position 4 – the pleural view
On the left side of the patient:
– Spleen
– Diaphragm
– Lung tissue
On the right side of the patient:
– Liver
– Diaphragm
– Lung tissue
The diaphragm is a mandatory landmark to identify and display clearly on the screen
The scanning planes of the pleural views are coronal (frontal)
The orientation marker (OM – green spot) on the transducer is directed cranially and the hand is rested on the bed
Due to the convention of cardiac ultrasound, the orientation indicator is placed on the right side of the screen
Consequently, the lungs are displayed on the right side of the screen, and the solid organs on the left side of the screen
The solid organs below the diaphragm are:
– The liver (the patient’s right side)
– The spleen (the patient’s left side)
Pleural effusion, if present, will appear between the diaphragm and the lung surface
– Optimal patient position: supine and always with elevated thorax
– Hold the transducer as you prefer
– Place the transducer on the lateral part of the thorax at the edge of the lower rib
– OM should be directed cranially
– Adjust the transducer position with small incremental tilt and rotational movements
– Have the desired image clear in your mind and watch the screen until you achieve it
– The diaphragm is a mandatory landmark
– Depth: 14-18 cm
Echocardiographic convention applies to the FATE examination of the pleura
– i.e. the orientation indicator is on the right side of the screen
The liver is used as the reference point when diaphragm and pleura on the patient’s right side are examined
The spleen is used as the reference point when diaphragm and pleura on the patient’s left side are examined
Evaluation of pleural effusion should always be performed with the thorax in the semierect position
The diaphragm is a mandatory landmark – never insert a needle unless you have identified the diaphragm
Page 1 on the FATE card is used for this part of the FATE examination
Position 4 is indicated on the FATE torso in the lower right corner of page 1 on the FATE card
The target image is displayed in the lower left corner of page 1 on the FATE card
Study the FATE card and memorize position 4 and the target image before beginning the examination
You can download the FATE card from: usabcd.org/FATE-card
The FATE position 4 is called the pleural view
Two different views are obtained in the FATE position 4:
– The left side pleural view
– The right side pleural view
The position obtained in position 4 is shown on page 1 of the FATE card
The pleural views are suitable for a quick evaluation of:
– Pleural effusion
– Atelectasis
– Pulmonary oedema
– Correct intubation
– Pneumothorax
This lesson will go through the positions in detail, focusing on how to obtain and interpret the images
The two pleural views are obtained on the lower left and right side of the thorax respectively
The pleural views are obtained by placing the transducer as illustrated on the torso
The orientation marker on the transducer is pointing cranially
In the following we will go through the positions in detail, focusing on how to obtain and interpret the 2D ultrasound image
