Download Focus Assessed Transthoracic Echo - Fate

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.
2.5 cm
IVS 6-10 mm
LV LVDd 3.5-5.5 cm
LVSd 2.0-4.0 cm
MSS< 1 cm
LA diam.
2.5 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
LA
Pos 2: Dilated LA+LV
Pos 2: Dilated RA+RV
8
LV
RV
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 right
(patient´s
back)
Point left
(patient´s right
shoulder)
LV
LA
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