The PLAX view is the only view in the basic FATE protocol where the orientation marker on the transducer is directed towards the right shoulder

It is the standard view for measuring the dimensions of the heart

The image quality is often improved with expiration

Left lateral position – approx. 70-90 degrees – is generally the optimal position for the PLAX view

The apex is generally not seen

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 grey arrow points towards the patient’s right shoulder in this particular view

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)