Back to Course

Focused Cardiac Ultrasound

0% Complete
0/0 Steps

  1. Welcome

    Introduction to FoCUS
    2 Topics
  2. Section 1
    Video: Cardiac Anatomy
  3. Cardiac Anatomy
    3 Topics
  4. Section 2
    Key Video: Obtaining the 5 Views
  5. Acquisition & the 4Ps
    4 Topics
    |
    1 Quiz
  6. Acquiring The 5 Views
    5 Topics
    |
    1 Quiz
  7. Clinical Case Scenario
  8. Section 3
    Interpretation
    11 Topics
    |
    2 Quizzes
  9. Interpretation: The RUSH Protocol
    1 Quiz
  10. Section 4
    Medical Management
  11. Foundations of Echocardiography
  12. References
    References & Further Reading

Quizzes

Focused Cardiac Ultrasound Acquiring The 5 Views Parasternal Short Axis
Lesson 6, Topic 2
In Progress

Parasternal Short Axis

Lesson Progress
0% Complete

4 Levels

The parasternal short axis view is obtained by rotating the probe 90 degrees counter clockwise so that the probe orientation marker now faces the patients left shoulder. There are 4 levels at which images are obtained in the short axis plane:

  1. Aortic Level
  2. Basal / Mitral Level
  3. Mid Papillary Level
  4. Apical Level
Parasternal Shot Axis Views.

The 4 levels are further detailed in the following video. For purposes of point of care ultrasound, we will consider the mid-papillary view in more detail.

PSAX Views – Aortic Level to Apical Level.

Mid Papillary Parasternal Short Axis

How To Obtain This View:

The PSAX view is obtained by rotating the transducer 90 degrees clockwise from the PLAX view. The probe should be in the left parasternal 3rd to 4th intercostal space, with the probe marker facing the left shoulder.

The patient should lie in the left lateral decubitus position with the left arm under the head.

Probe position on the chest for the PSAX view.
Parasternal short axis
Anatomical image of the parasternal short axis view. Image by Patrick J. Lynch and C. Carl Jaffe – Creative Commons CC BY 2.5

The 4 LV walls are seen – Anterior, Inferior, Septal & Lateral. Presence of papillary muscles confirms that the probe is at mid-papillary level.

Parasternal short axis
PSAX view showing a circumferential pericardial effusion. The view is at the level of the MV – the fish mouth appearance of the valve within the LV cavity is seen. Image from POCUS atlas.

Useful For Assessment Of:

Left Ventricle:

All 4 walls of the LV can be seen. This makes this view ideal for assessment of global and regional LV systolic function. The mid-papillary segments of the LV are usually imaged in FCU, but the apical and basal segments of the LV can be visualized with probe movement towards the apex or base of the heart. Assessment of intravascular volume can be made by looking at the end diastolic and end systolic LV cavity sizes.

LV walls and wall thickness measurement. This patient has severe LVH.

Right Ventricle:

RV size and contractility should be assessed in combination with the other FCU views for a complete evaluation.

Interventricular Septum:

The PSAX view is ideal to look for septal flattening or paradoxical septal movement which is present in conditions associated with RV volume and / or pressure overload.

Pericardial Space:

Finally, pericardial effusions can be picked up. Circumferential presence of fluid indicates an effusion of reasonable size.

PSAX views
Image shows PSAX view at different levels – basal, mid-papillary & aortic level. Image from: @pocus101 (twitter)
Parasternal Short Axis