Module 2: PSAX protocol

Question 1

For PSAX images how is the patient positioned?

Answer 1

Left lateral Decubitus

Question 2

What are some tips for positioning the patient to get good views?

Answer 2

Drop the right shoulder back to open up the intercostal spaces

Question 3

How do we get the PSAX view?

Answer 3

From PLAX view, Tilt AV into center, then turn 90 degrees, keeping the same tilt

Question 4

Where should we tilt the indicator for PSAX view?

Answer 4

Patients left shoulder

Question 5

To get different PSAX views what will we do?

Answer 5

Slide and angle along the long axis of the heart

Question 6

What are some tips if you have trouble with PSAX?

Answer 6

1. When in doubt, go back to PLAX to get centered
2. Don’t over rotate!

Question 7

If we over rotate for when getting into the PSAX window how do we know?2

Answer 7

1. Make sure that the AV is round and symmetrical at base, and not opening sideways
2. MV is round and symmetrical at MV level opening sideways

Question 8

What is important for us to see for a PSAX base level? 3

Answer 8

Must see three things clearly
1. TV
2. AV
3. PV must be seen, but may not open up to PA

Question 9

Where should we have the focus for the PSAX base image?

Answer 9

AV

Question 10

Where should the depth be placed for a PSAX base image?

Answer 10

Slightly past LA

Question 11

How do we get into the PSAX AV zoom window?

Answer 11

1. Use write zoom by punching the zoom dial, then adjust size
2. Make sure there is some room around the AV

Question 12

What should we see during the PSAX- AV zoom?

Answer 12

All three leaflets

Question 13

What happens if you can’t see all the leaflets open symmetrically during PSAX - AV zoom?

Answer 13

You are off axis

Question 14

Why do we use zoom for a PSAX AV window?

Answer 14

Look for abnormal AV (congenital or bicuspid valves)

Question 15

What is AV sclerosis?

Answer 15

Thickening/ Calcification at the AV cusps

Question 16

How do we get into the PSAX- TV focus view?

Answer 16

1. From the PSAX base view tilt the probe to center the TV centering required
2. Sector down on TV sector is not required

Question 17

What should we see on a PSAX TV focus?

Answer 17

2 TV leaflets clearly

Question 18

For the PSAX TV focus view what level should we be at?

Answer 18

Should still be at the level of the AV, or you may be too low

Question 19

How should we get into the PSAX PA level window?

Answer 19

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

Question 20

What should we see clearly in the PSAX PA level?

Answer 20

1. RVOT
2. PV
3. MPA + Bifurcation (left and right PA)

Question 21

The PSAX PA level image is most similar to which other view?

Answer 21

PLAX PV view

Question 22

Which PSAX window is the most superior?

Answer 22

PSAX PA level

Question 23

How should we get into the PSAX MV level window?

Answer 23

Can usually be obtained by angling slightly towards the apex from base level

Question 24

How should the MV appear in the PSAX MV level window?

Answer 24

Round and symmetrical if not you are off axis, most likely over rotated clockwise

Question 25

In the PSAX MV level if the MV opens towards the LT side of the screen how should we rotate?

Answer 25

clockwise

Question 26

If the M appears to open to the RT side of the screen how should we rotate?

Answer 26

counterclockwise

Question 27

What should see during the PSAX MV window? 6

Answer 27

1. RV free wall 2. RV chamber 3. IVS 4. AMVL 5. PMVL 6. MV annulus

Question 28

The MV posterior leaflet edge should appear how during PSAX MV level?

Answer 28

Equidistant from all sections of the posterior wall. *Not lopsided*

Question 29

How should we get into the PSAX LV base level?

Answer 29

**Millimeters below the MV level at the level of the chordae tendonae**

Question 30

What should we see during the PSAX LV base image?

Answer 30

1. Chordae which resemble eyelashes 2. Maybe some floating papillary muscles

Question 31

How do we know if we are to superior and out of the window of the PSAX LV base window?

Answer 31

We see MV leaflets

Question 32

How do we know if we are to inferior and out of the window of the PSAX LV base?

Answer 32

We see papillary muscles that are attached to the LV wall

Question 33

How do we get into the PSAX mid(pap) level window?

Answer 33

Slide towards the apex

Question 34

How should the LV appear during the PSAX mid (pap) level?

Answer 34

LV should appear round

Question 35

How should the Pap muscles look during the PSAX Mid (pap) level?

Answer 35

**Should both be attached to the LV wall** If not we are off rotation and most likely over rotated too far clockwise

Question 36

What are structures we should see in the PSAX mid (pap) level? 6

Answer 36

1. RV free wall 2. RV chamber 3. IVS 4. two Pap muscles (Anterolateral and Posteromedial) 5. Pericardium 6. All walls of the mid LV simultaneously

Question 36

What are structures we should see in the PSAX mid (pap) level? 6

Answer 36

1. RV free wall 2. RV chamber 3. IVS 4. two Pap muscles (Anterolateral and Posteromedial) 5. Pericardium 6. All walls of the mid LV simultaneously

Question 37

How do we get to the PSAX Apex level?

Answer 37

Slide further towards apex and angle further towards apex as well

Question 38

The PSAX apex level what should we see?

Answer 38

All the walls of the LV and a sliver of the RV

Question 39

What is the PSAX apical level window good for?

Answer 39

Pericardial effusion

Question 40

Why is knowing perfusion territories important?

Answer 40

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**

Question 41

Label the perfusion zones

Answer 41