The parasternal long axis view (PLAX) shows how the image should appear by convention on the screen

Observe the base of the heart at the right side of the screen, and the apex of the heart at the left side of the screen – in contrast to the subcostal 4-chamber view

In this view the aortic (AO) and mitral valves (MV) can be evaluated

The parasternal long axis view is suitable for a quick evaluation of:
– Pathology
– Wall thickness (M-mode)
– Chamber dimensions (M-mode)
– Mitral septal separation (M-mode)
– Aortic and mitral valves

The parasternal short axis view (PSAX) shows how the image should appear by convention on the screen

This view is suitable for a quick evaluation of:
– Pathology
– Dimensions of cavities: Left and right ventricle
– Myocardium: Left and right ventricle
– Left ventricular function:
– Global
– Regional (Myocardium with blood supply from all three coronary arteries represented)

The pleural views are obtained from position 4

As part of the FATE examination these structures should be visualised:
– Liver (right side)
– Spleen (left side)
– Diaphragm (both sides)

By convention the orientation indicator on the screen is placed at the right side of the screen by the cardiologists, but on the left side of the screen by radiologists and emergency physicians

Since the orientation marker on the transducer should point in the cranial direction, the diaphragm is seen on the right side of a cardiologist’s screen (when cardiac transducer in chosen) and on the left side of a radiologist’s / emergency physician’s screen (when non-cardiac transducers are employed)

This can be a bit confusing, but is easily adapted when the convention is understood

The pleural views are suitable for evaluation of:
– Pleural effusion
– Atelectasis/lung parenchyma
– Pneumothorax
– Pulmonary edema
– Correct intubation confirmed by bi-lateral lung sliding

The apical 4-chamber view is obtained from position 2

In this view these cardiac chambers can be visualised:
– Left atrium (LA)
– Right atrium (RA)
– Left ventricle (LV)
– Right ventricle (RV)

The apical 4 chamber view below shows how the image by convention should appear on the screen

This view is suitable for a quick qualitative evaluation of:
– Pathology
– Wall thickness
– Chamber dimensions
– Bi-ventricular function

At the left parasternal position – FATE position 3 – two different views are obtained

1) The parasternal long axis view (PLAX)

2) The parasternal short axis view (PSAX)

The parasternal long axis view (PLAX) is obtained from position 3 by aiming the orientation marker of the transducer at the patient’s right shoulder

In this view these cardiac structures can be visualised:
– Left atrium (LA)
– Left ventricle (LV)
– Right ventricle (RV)
– The aortic root (AO)
– The mitral valve

The FATE card is made to assist your memory

The FATE card shows you:
– Where to place the transducer on the thorax for each of the four positions
– The direction of the transducer orientation marker (OM)
– The rotation of the transducer
– The expected sonographic image

Standard cardiac abbreviations used throughout the course:
LA = left atrium
RA = right atrium
LV = left ventricle
RV = right ventricle
AO = aorta
IVS = interventricular septum
IAS = interatrial septum

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

A systematic approach is a prerequisite to successful imaging performed by a novice

Always have the FATE card in front of you or use the posters available during the workshops

Ask yourself – and during the workshop also the rest of the group:
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?