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
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
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 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
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 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
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.
