Focus Assessed Transthoracic Echo (FATE) Scanning through position 1-4 in the most favourable sequence Basic FATE views Point right (patient´s left) RV RA 0° Point right (patient´s left back) RV LV RA LA Pos 1: Subcostal 4-chamber Point left (patient´s right shoulder) LA Pos 2: Apical 4-chamber Point right (patient´s left shoulder) RV LV LV RV AO LV LA Pos 3: Parasternal long axis Pos 3: Parasternal LV short axis Right Point cranial Liver/spleen Diaphragm Lung Pos 4: Pleural scanning Left Focus Assessed Transthoracic Echo (FATE) (European Journal of Anaesthesiology 2004; 21: 700-707) 1. 2. 3. 4. 5. 6. Look for obvious pathology Assess wall thickness + chamber dimensions Assess bi - ventricular function Image pleura on both sides Relate the information to the clinical context Apply additional ultrasound Dimensions and contractility: FS = (LVDd - LVSd) LVDd EF 2 x FS LV MV Aorta RV-wall 5 mm RV 2.0-3.0 cm AO diam. 3.5 cm IVS 6-10 mm LV LVDd 3.5-5.5 cm LVSd 2.0-4.0 cm MSS< 1 cm LA diam. 3.5 cm PW 6-10 mm Start of QRS (LVDd) Max. post wall contract (LVSd) time The global function of the heart is determined by the interaction between: Right ventricle Systole: Preload Afterload Contractility Heart rate Diastole: Compliance Relaxation Heart rate Left Ventricle Systole: Preload Afterload Contractility Heart rate Diastole: Compliance Relaxation Heart rate Hemodynamic instability, perform a systematic evaluation of these determinants plus concomitant pathology: (e.g. pericardial effusion, pulmonary embolus, pleural effusion, pneumothorax, valvulopathy, dissection, defects) Important pathology 1 2 3 RV RV RV RA RA RA LV LV LA LA Pos 1: Pericardial effusion 4 Pos 1: Dilated RA+RV 5 RV RA RV LA 7 Pos 1: Dilated LA+LV 6 LV RA Pos 2: Pericardial effusion LV LA RA LA Pos 2: Dilated RA+RV 8 LV RV LV LA Pos 2: Dilated LA+LV 9 RV RV RV LV LV Pos 3: Pericardial effusion 10 LV Pos 3: Dilated RV 11 AO LA Pos 3: Dilated LV+LA 12 RV RV LV Pos 3: Dilated LV AO LV RV LV LA Pos 3: Hypertrophy LV+Dilated LA Pos 3: Hypertrophy LV PATHOLOGY TO BE CONSIDERED IN PARTICULAR: • Post OP cardiac surgery, following cardiac catheterisation, trauma, renal failure, infection. • Pulmonary embolus, RV infarction, pulmonary hypertension, volume overload. • Ischemic heart disease, dilated cardiomyopathy, sepsis, volume overload, aorta insufficiency. • Aorta stenosis, arterial hypertension, LV outflow tract obstruction, hypertrophic cardiomyopaty, myocardial deposit diseases. Extended FATE views 60° Point right (patient´s left shoulder) LIVER LV IVC LA RA Pos 1: Subcostal Vena Cava Pos 2: Apical 2 - Chamber 0° 120° Point left (patient´s right shoulder) LV LA Point right (patient´s back) LV RV RV LA AO AO Pos 2: Apical 5 - Chamber Pos 2: Apical Long - axis Point right (patient´s left shoulder) Point right (patient´s left shoulder) RV R RV RA NC L PA LA Pos 3: Parasternal short axis mitral plane Pos 3: Parasternal aorta short axis CW: Peak pressure: V2 x 4; AO < 2 m/s; PA < 1 m/s; TI < 2.5 m/s PW: Mitral Inflow desc. time 140 - 240 ms; MAX E < 1.2 m/s; E/A >1 (Age dependent) TVI: E/e´< 8-10; IVC < 20 mm; 50% collaps during inspiration is normal Systolic Ventricular Function Ventricle M-Mode Normal LV Pos 3, PS long EF (%) ≥ 55 LV Pos 3, PS long FS (%) ≥ 25 LV Pos 3, PS long MSS (mm) < 10 LV Pos 2, AP 4ch Mapse (mm) ≥ 11 RV Pos 2, AP 4ch Tapse (mm) 16 - 20 Right and left ventricle Eye Balling use all views Mild 45 - 54 20 - 24 7 - 12 9 - 10 11 - 15 Moderately 30 - 44 15 - 19 13 - 24 6-8 6 - 10 Severely < 30 < 15 > 24 <6 <6 For additional information: www.usabcd.org Disclaimer: The authors do not assume any responsibility for the use of this FATE card. Layout: Department of Communication, Aarhus University Hospital, Skejby • ES0410LB Point cranial