Focus Assessed Transthoracic Echo (FATE)
Scanning through position 1-4 in the most favourable sequence
Basic FATE views 0°
Point right Point right
(patient´s left) (patient´s
left back)
RV LV
RA RV
LV
RA LA
LA
Pos 1: Subcostal 4-chamber Pos 2: Apical 4-chamber
Point left Point right
(patient´s right (patient´s left
shoulder) shoulder)
RV RV
LV AO LV
LA
Pos 3: Parasternal long axis Pos 3: Parasternal LV short axis
Point cranial Right Left
Liver/spleen
Diaphragm
Lung
Pos 4: Pleural scanning
Focus Assessed Transthoracic Echo (FATE)
(European Journal of Anaesthesiology 2004; 21: 700-707)
1. Look for obvious pathology
2. Assess wall thickness + chamber dimensions
3. Assess bi - ventricular function
4. Image pleura on both sides
5. Relate the information to the clinical context
6. Apply additional ultrasound
Dimensions and contractility:
(LVDd - LVSd)
FS =
LVDd
EF 2 x FS
LV MV Aorta
RV-wall 5 mm
AO diam.
RV 2.0-3.0 cm
2.5 cm
IVS 6-10 mm
MSS< 1 cm
LV LVDd 3.5-5.5 cm
LVSd 2.0-4.0 cm
LA diam.
2.5 cm
PW 6-10 mm
Start of QRS Max. post wall contract
(LVDd) (LVSd)
time
The global function of the heart is determined by the interaction between:
Right ventricle Left Ventricle
Systole: Diastole: Systole: Diastole:
Preload Compliance Preload Compliance
Afterload Relaxation Afterload Relaxation
Contractility Heart rate Contractility Heart rate
Heart rate 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
LV
LA
LA LA
Pos 1: Pericardial effusion Pos 1: Dilated RA+RV Pos 1: Dilated LA+LV
4 5 6
RV LV
LV LV RV
RV
RA LA RA
RA LA LA
Pos 2: Pericardial effusion Pos 2: Dilated RA+RV Pos 2: Dilated LA+LV
7 8 9
RV
RV AO
RV LV
LV LV
LA
Pos 3: Pericardial effusion Pos 3: Dilated RV Pos 3: Dilated LV+LA
10 11 12
RV
AO
RV LV RV LV
LV
LA
Pos 3: Dilated LV 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 cranial Point right
(patient´s left
LIVER shoulder)
LV
Disclaimer: The authors do not assume any responsibility for the use of this FATE card. Layout: Department of Communication, Aarhus University Hospital, Skejby • ES0410LB
IVC
RA LA
Pos 1: Subcostal Vena Cava Pos 2: Apical 2 - Chamber
120° 0°
Point left Point right
(patient´s right (patient´s
shoulder) back)
LV RV LV
RV
LA AO LA
AO
Pos 2: Apical Long - axis Pos 2: Apical 5 - Chamber
Point right Point right
(patient´s left (patient´s left
shoulder) shoulder)
RV
R
RV
NC L
RA 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 Mild Moderately Severely
LV Pos 3, PS long EF (%) ≥ 55 45 - 54 30 - 44 < 30
LV Pos 3, PS long FS (%) ≥ 25 20 - 24 15 - 19 < 15
LV Pos 3, PS long MSS (mm) < 10 7 - 12 13 - 24 > 24
LV Pos 2, AP 4ch Mapse (mm) ≥ 11 9 - 10 6-8 <6
RV Pos 2, AP 4ch Tapse (mm) 16 - 20 11 - 15 6 - 10 <6
Right and left ventricle Eye Balling use all views
For additional information: www.usabcd.org
