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

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 embolus and global function of both the right and the left ventricle. The pathology will be explained later

The image will often improve with expiration

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

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

Position 3 is indicated on the FATE torso in the lower right corner of the card

The images in the middle of page 1 are the target images to be obtained in position 3

Study the FATE card and memorize position 3 and the target image to look for before beginning the examination

You can get the FATE card in Google Play or the AppStore

The FATE position 3 is called the parasternal view

Two different views are obtained in the FATE position 3. They are named:
– The parasternal long axis view (PLAX) and
– The parasternal short axis view (PSAX)

The positions are obtained in position 3 of the FATE card

The parasternal views are suitable for a quick qualitative evaluation of:
– Pathology (pericardial effusion, pulmonary embolus)
– Wall thickness
– Chamber dimensions
– Bi-ventricular function

You will now be taken through these two positions in detail, focusing on how to obtain and interpret the right 2D ultrasound image

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

The orientation marker (OM – green arrow) is pointing towards the left side of the patient (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 on the screen corresponds to the blue margin of the yellow fan

The red radius on the screen corresponds to the red margin of the yellow fan

The left ventricle is displayed on the right side of the screen, when the OM is correctly pointing towards the patient

The structures identified in the FATE position 2 – the apical view

– Apex of the heart
– RA: Right atrium
– RV: Right ventricle
– LA: Left atrium
– LV: Left ventricle
– Lateral wall
– Decending thoracic aorta
– Anterior mitral leaflet
– Posterior mitral leaflet
– 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, basis of the heart, right atrium, right ventricle, left atrium, left ventricle, inter-ventricular septum, inter-atrial septum.

The target view is a 4 chamber image corresponding to the scanning plane indicated on the torso in the image

All four chambers are viewed in long axis

As the transducer is placed at the apex both the right (RV) and the left (LV) ventricles appear in the near field and the right (RA) and left (LA) atria appears in the far field

When a 4 chamber view is present on the screen, this is per definition a zero degree rotation