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

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

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

– 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