1.02 Parasternal Long Axis View (LAX)

What position should a patient be in for this view?

LLD (with sponge on their back to held support them).

How is an EKG performed?

3 EKG electrodes are placed on the patient to display a single EKG lead. One is placed on the right arm, one on the left arm, and the other on the left chest (left lower belly).

What are the four different selections for transducers?

* 3-3.5 MHz for averaged-sized adults
* 2-2.4 MHz for large adults
* 5-7.5 MHz for children
* 7.5-10 MHz for neonatals

What is the footprint?

The contact area of the ultrasound transducer with the skin surface.

What is the image marker?

Describes the orientation index image marker on all ultrasound transducers.

What does movement of the transducer imply?

The actual movement of the footprint of the transducer on the chest wall along the scan plane. This is done without changing the rotation or tilt of the transducer.

What does tilting a transducer mean?

The up and down movement of the transducer from a fixed point on the chest wall. Th footprint does not move, it is just rocked up and down, thus tilting.

What is angulation of a transducer?

Refers to the side to side movement of the transducer from a fixed point on the chest wall. The footprint does not move, but is angled side to side (to midline or laterally).

What is rotation?

Refers to pivoting or twisting of the transducer from a fixed position on the chest wall. You can rotate clockwise or anti-clockwise.

What is depth?

A control that adjusts the vertical field of view of the image.

The depth of an image affects what?

The frame rate.

The deeper the field of view, the (greater/less) time required for the signal to return to the transducer and the (faster/slower) the frame rate.

Greater; slower

The closer the field of view, the (greater/less) time required for the signal to return to the transducer and the (faster/slower) the frame rate.

Less; slower

In order to maintain the frame rate, the smallest view of view should be employed while doing what?

Maintaining all of the anatomy within the image sector.

What is the focal zone?

The region of the image at which the ultrasound beam is the narrowest (where lateral resolution is the best).

Where should the focal zone be set at?

Slightly behind what you are looking at.

What is gain?

A control that amplifies the ultrasound signal.

What does gain do?

It adjusts the displayed amplitude of all received signals and affects the brightness of signals on the display.

Optimal gain settings should NOT do what?

Show lots of echos in fluid, like blood, unless a pathology is present.

What is the parasternal LAX?

Parasternal long axis view, this is where the heart is sliced vertically.

Where on the body is the LAX view performed?

Between the 3rd-5th intercostal space, where the transducer is close to the sternum, specifically the left sternal border.

In parasternal LAX, is the transducer close to the sternum or far?

Close.

Where should the orientation marker be pointing towards to obtain a parasternal LAX?

Towards the patient’s right shoulder. Image the heart inside the body.

When looking at an ultrasound image, how deep should your depth be?

Where there is about a thumb size of myocardium from the bottom of the screen to the back of the heart.

For optimal images, the transducer should be angled in what way to the structure of interest?

Perpendicular to the structure in interest (90°).

Where is the anterior wall of the RV in a parasternal LAX view?

At the top of the view.

Where is the RV chamber in an parasternal LAX view?

At the top, below the anterior wall of the RV.

Where is the interventricular septum in a parasternal LAX view?

The tissue below the RV and above of the LV.

Where is the aortic root in a parasternal LAX view?

On the mid right part of the screen; to the right of the aortic valve.

Where is the aortic valve in a parasternal LAX view?

To the left of the aortic root.

Where is the right coronary cusp of the aortic valve in a parasternal LAX view?

Where is the non coronary cusp of the aortic valve in a parasternal LAX view?

Where is the LV outflow tract in a parasternal LAX view?

To the left of the aortic valve.

Where is the LV in a parasternal LAX view?

Where is the LA in a parasternal LAX view?

Where is the mitral valve in a parasternal LAX view?

Where is the anterior mitral valve leaflet in a parasternal LAX view?

Where is the posterior mitral valve leaflet in a parasternal LAX view?

Where is the coronary sinus in a parasternal LAX view?

(hard to see in this picture)

Where is the descending aorta in this picture?

(not visible in this picture but it is circled where it would be)

Where is the LV posterior wall (LVPW or inferolateral wall)?

How to you get the the parasternal long axis right ventricle inflow tract (LAX RVIT) from the parasternal LAX?

By angling the transducer towards the patient’s right hip.

What structures can be seen in a parasternal LAX RVIT?

* RA
* RV
* Tricuspid valve
* Coronary sinus
* IVC
* Eustachian valve

How do you get to a parasternal long axis right ventricle outflow tract (LAX RVOT) from parasternal LAX view?

By angling the transducer towards the patient’s left shoulder.

What structures can be seen in a parasternal LAX RVOT?

* RVOT
* PV
* Main pulmonary artery (MPA)
* Right pulmonary artery (RPA)

What is a good way of remembering whether or not you are looking at parasternal LAX RVIT or RVOT?

If you are IN, you’re HIP, but if you’re OUT, you get the shoulder.