The target view is a 4 chamber image showing the structures of the target image, corresponding to the scanning plane illustrated on the torso in the picture

As the RA and RV are placed anteriorly they will appear in the near field and LA and LV appear in the far field

The probe is placed on the skin of the thorax, the yellow fan-like sector (scanning plane) diverges from the probe and intersects the heart

The orientation marker (OM – grey arrow) of the probe is pointing towards the left side of the patient. The OM corresponds to the orientation indicator (OI) on the right side of the screen

To understand how the sector is presented on the screen, imagine that the upper border of the screen is the skin, and the sector diverges from the probe placed on the skin

The blue radius of the sector on the screen corresponds to the blue border of the yellow fan

The red radius of the sector on the screen corresponds to the red border of the yellow fan

The apex of the heart is displayed on the right side of the screen, when the OM is correctly pointing towards the patient’s left shoulder (the right side of the screen)

The structures identified in the FATE position 1 – the subcostal view:

– Liver
– Apex of the heart
– Base of the heart
– RA: Right atrium
– RV: Right ventricle
– LA: Left atrium
– LV: Left ventricle
– IVS: Inter-ventricular septum
– IAS: Inter-atrial septum

In this video the anatomical structures are indicated on the beating heart

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

– Optimal patient position: supine or sitting; image improves in 50% with partial inspiration

– Hold the transducer as a screw driver prone with your right hand

– Place the transducer subcostally, slightly on the right side of the abdomen

– OM should be directed towards the patient’s left

– To achieve correct anatomical alignment rotate the transducer approx. 20

You have now been introduced to the basic FATE positions and views and the FATE card

Four different positions, or “windows”, on the thorax are included in a full basic FATE examination

From these positions 6 imaging views can be achieved:
– Position 1: Subcostal 4-chamber view (S4CH), C in the image
– Position 2: Apical 4-chamber view (A4CH), D in the image
– Position 3: The parasternal long-axis view (PLAX), A in the image
– Position 3: The parasternal short-axis view (PSAX), B in the image
– Position 4: Pleural windows – 2 views, right pleura and left pleura, not shown in the image

In the following lessons a systematic and comprehensive review of the individual views will be given

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

Position 1 is indicated on the FATE torso in the lower right corner of the card

The image in the upper left corner of page 1 of the FATE card is the target image to be obtained in position 1

Study the FATE card and memorise position 1 and the target image before beginning the examination

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

The FATE position 1 is called the subcostal or subxiphoid view

The subcostal view is a 4 chamber view, imaging all 4 chambers of the heart

The position obtained in position 1 is indicated on page 1 of the FATE card

The subcostal 4 chamber view is suitable for a quick qualitative evaluation of:
– Pathology (pericardial effusion, pulmonary embolus)
– Wall thickness
– Chamber dimensions
– Bi-ventricular function

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

The inferior vena cava (IVC) is also found in this lesson

The subcostal view is obtained by placing the transducer in the subcostal position, slightly to the right of the midline

The orientation marker on the transducer should be directed towards the patient’s left

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

The parasternal short axis view (PSAX) is obtained from position 3 by aiming the orientation marker on the transducer at the patient’s left shoulder

In this view two cardiac chambers can be visualized:
– Left ventricle (LV)
– Right ventricle (RV)