Medical student
Position 2: Transducer placement and orientation
The apical view is obtained by placing the transducer where the cardiac apex is most easily palpated
The orientation marker on the transducer should be directed towards the patient’s left side
Notice the location of the heart in the thoracic cavity and the orientation of the ultrasound sector beam
Subcostal 4 chamber view – important points
Forced inspiration will push the diaphragm down and will usually facilitate the subcostal approach
The subcostal 4 chamber view is suitable for evaluation of pericardial effusion, pulmonary embolus and global function of both the right and the left ventricle
Position 2: The apical 4 chamber view (A4CH)
The FATE position 2 is called the apical view
The apical view is a 4 chamber view (A4CH) imaging all 4 chambers of the heart
The position is obtained in position 2 indicated on page 1 of the FATE-card
The apical 4-chamber view is 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 the position in detail, focusing on how to obtain and interpret the right 2D ultrasound image
Position 2 and the FATE card
Page 1 on the FATE card is used for this part of the FATE examination
Position 2 is indicated on the FATE torso in the lower right corner of page 1 on the card
The upper right image is the target image to be obtained in this position
Study the FATE card and memorize the position and what target image to look for before beginning the examination
Position 1: Anatomy and 2D image
The structures identified in the FATE position 1 – the subcostal view
– Liver
– Apex of the heart
– Base of the heart
– RA: Right atrium
– RV: Right ventricle
– LA: Left atrium
– LV: Left ventricle
– IVS: Inter-ventricular septum
– IAS: Inter-atrial septum
Position 1: Viewing the scanning plane on the screen
The probe is placed on the skin of the thorax, the yellow fan-like sector (scanning plane) diverges from the probe and intersects the heart
The orientation marker (OM – green arrow) of the probe is pointing towards the left side of the patient. The OM corresponds to the orientation indicator (OI) on 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 of the sector on the screen corresponds to the blue border of the yellow fan
The red radius of the sector on the screen corresponds to the red border of the yellow fan
The apex of the heart is displayed on the right side of the screen, when the OM is correctly pointing towards the patient’s left shoulder (the right side of the screen)
Video: Cardiac structures of beating heart
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
Position 1: Transducer placement and orientation
The subcostal view is obtained by placing the transducer in the subcostal position, slightly to the right of the midline
The orientation marker on the transducer should be directed towards the patient’s left
Notice the location of the heart in the thoracic cavity and the orientation of the ultrasound sector beam (the scanning plane)
Position 1: Scanning plane and 2D image
The target view is a 4-chamber image showing the structures of the target image, corresponding to the scanning plane illustrated on the torso of the picture
As the RA and RV are placed anteriorly they will appear in the near field and LA and LV appear in the far field