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
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)
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
– 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 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)
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
