Module 2: PSAX protocol Flashcards
For PSAX images how is the patient positioned?
Left lateral Decubitus
What are some tips for positioning the patient to get good views?
Drop the right shoulder back to open up the intercostal spaces
How do we get the PSAX view?
From PLAX view, Tilt AV into center, then turn 90 degrees, keeping the same tilt
Where should we tilt the indicator for PSAX view?
Patients left shoulder
To get different PSAX views what will we do?
Slide and angle along the long axis of the heart
What are some tips if you have trouble with PSAX?
- When in doubt, go back to PLAX to get centered
- Don’t over rotate!
If we over rotate for when getting into the PSAX window how do we know?2
- Make sure that the AV is round and symmetrical at base, and not opening sideways
- MV is round and symmetrical at MV level opening sideways
What is important for us to see for a PSAX base level? 3
Must see three things clearly
1. TV
2. AV
3. PV must be seen, but may not open up to PA
Where should we have the focus for the PSAX base image?
AV
Where should the depth be placed for a PSAX base image?
Slightly past LA
How do we get into the PSAX AV zoom window?
- Use write zoom by punching the zoom dial, then adjust size
- Make sure there is some room around the AV
What should we see during the PSAX- AV zoom?
All three leaflets
What happens if you can’t see all the leaflets open symmetrically during PSAX - AV zoom?
You are off axis
Why do we use zoom for a PSAX AV window?
Look for abnormal AV (congenital or bicuspid valves)
What is AV sclerosis?
Thickening/ Calcification at the AV cusps
How do we get into the PSAX- TV focus view?
- From the PSAX base view tilt the probe to center the TV centering required
- Sector down on TV sector is not required
What should we see on a PSAX TV focus?
2 TV leaflets clearly
For the PSAX TV focus view what level should we be at?
Should still be at the level of the AV, or you may be too low
How should we get into the PSAX PA level window?
You might be able to get this by simply tilting to center the PC
you may need to angle more superiorly with a slight CC rotation
What should we see clearly in the PSAX PA level?
- RVOT
- PV
- MPA + Bifurcation (left and right PA)
The PSAX PA level image is most similar to which other view?
PLAX PV view
Which PSAX window is the most superior?
PSAX PA level
How should we get into the PSAX MV level window?
Can usually be obtained by angling slightly towards the apex from base level
How should the MV appear in the PSAX MV level window?
Round and symmetrical if not you are off axis, most likely over rotated clockwise
In the PSAX MV level if the MV opens towards the LT side of the screen how should we rotate?
clockwise
If the M appears to open to the RT side of the screen how should we rotate?
counterclockwise
What should see during the PSAX MV window? 6
- RV free wall
- RV chamber
- IVS
- AMVL
- PMVL
- MV annulus
The MV posterior leaflet edge should appear how during PSAX MV level?
Equidistant from all sections of the posterior wall.
Not lopsided
How should we get into the PSAX LV base level?
Millimeters below the MV level at the level of the chordae tendonae
What should we see during the PSAX LV base image?
- Chordae which resemble eyelashes
- Maybe some floating papillary muscles
How do we know if we are to superior and out of the window of the PSAX LV base window?
We see MV leaflets
How do we know if we are to inferior and out of the window of the PSAX LV base?
We see papillary muscles that are attached to the LV wall
How do we get into the PSAX mid(pap) level window?
Slide towards the apex
How should the LV appear during the PSAX mid (pap) level?
LV should appear round
How should the Pap muscles look during the PSAX Mid (pap) level?
Should both be attached to the LV wall
If not we are off rotation and most likely over rotated too far clockwise
What are structures we should see in the PSAX mid (pap) level? 6
- RV free wall
- RV chamber
- IVS
- two Pap muscles (Anterolateral and Posteromedial)
- Pericardium
- All walls of the mid LV simultaneously
What are structures we should see in the PSAX mid (pap) level? 6
- RV free wall
- RV chamber
- IVS
- two Pap muscles (Anterolateral and Posteromedial)
- Pericardium
- All walls of the mid LV simultaneously
How do we get to the PSAX Apex level?
Slide further towards apex and angle further towards apex as well
The PSAX apex level what should we see?
All the walls of the LV and a sliver of the RV
What is the PSAX apical level window good for?
Pericardial effusion
Why is knowing perfusion territories important?
By knowing the names of all the walls and noticing abnormal movement of the wall we can indirectly diagnose ischemia or infarct of a particular artery
Label the perfusion zones
