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

– Optimal patient position: 80-90 degrees left lateral position; image often improves in expiration

– Place yourself on the patient’s right side

– Hold the transducer in pencil grip with your right hand

– Place the transducer in IC III-IV close to the sternum

– OM should be directed towards the patient’s right shoulder

– 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

– Depth: 12-16 cm

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

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

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

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

Study the FATE card and memorise position 3 and the target image before beginning the examination

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

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

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 patient’s right shoulder

This is the only basic FATE cardiac 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)

You have now learned:
– The anatomy of the FATE position 2 – the apical 4 chamber view
– How to obtain the correct image with respect to transducer orientation and the relationship to the presentation on the screen
– To appreciate the biological variations

Review this lesson if you are not confident about how to obtain the views

When you are confident move on to the next lesson on the FATE position 3, the parasternal long axis (PLAX) and short axis (PSAX) views

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

Before you start scanning, ask yourself:

1. Which position – 1, 2, 3 or 4?
2. How should I hold the probe?
3. Where should the orientation marker (OM) be pointing to?
4. What should appear on the screen?

Holding the probe in your right hand:

1. Apply gel without touching the footprint of the probe with the gel dispenser
2. Place the transducer on the chest wall where you expect to get the desired image
3. Circle with your hand until you recognise any anatomical structures on the screen
4. Then optimise the image in only one plane at a time by rotating / tilting / sliding

Anatomy

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 embolism and global function of both the right and the left ventricle. The pathology will be explained later

The image will often improve with expiration