The FATE position 3 is called the parasternal view

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

The positions are obtained in position 3 on the FATE card

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

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

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

In daily clinical practice it is important to know the blood supply to the heart

Remember the individual variations can be substantial

The target view is a 4 chamber image corresponding to the scanning plane indicated on the torso of the picture

All four chambers are viewed in long axis

As the transducer is placed at the apex, both the right (RV) and the left (LV) ventricles appear in the near field and the right (RA) and left (LA) atria appear in the far field

When a 4 chamber view is present on the screen, there is by definition zero degrees of rotation

The structures identified in the FATE position 2 – the apical view:

– Apex of the heart
– RA: Right atrium
– RV: Right ventricle
– LA: Left atrium
– LV: Left ventricle
– Lateral wall
– Descending thoracic aorta
– Anterior mitral leaflet
– Posterior mitral leaflet
– IVS: Inter-ventricular septum
– IAS: Inter-atrial septum

– Optimal patient position: 45 degrees left lateral position; image often improves with expiration

– Place yourself on the patient’s right side

– Hold the transducer with a pencil grip with your right hand

– Place the transducer at the apex beat

– OM should be directed backwards and to the patient’s left side

– 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: 14-18 cm

In the video below, the anatomical structures are indicated on the beating heart

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