Answer: Parasternal long axis

The parasternal long axis view is oriented to provide a view of the long axis of the left ventricle

Answer: Papillary muscles

The papillary muscles are often described as boots arising from the posterolateral and posteroseptal walls at the midventricular level

The papillary muscles can be found by fanning the probe in an apical direction from the mitral valve level

Answer: Fanning

Fanning the beam will shift the beam from the side wall where the diameter is minimized to the widest aspect of the ventricle

Remember, the LV cavity can be made to look artificially narrow, but it cannot be made to look artificially larger than it truly is

Answer: Left atrium

This is a very enlarged left atrium *based on the rule of thirds)

This should alert the scanner to possible mitral valve disease or LV diastolic dysfunction with chronically elevated LV end diastolic pressures

Answer: Mitral valve

In general the mitral valve should have thin, freely moving leaflets with similar echogenicity to the myocardium

Answer rotating

The error here is over-rotation such that the beam is oriented between a short axis and long axis plane of the LV (foreshortening of LV long axis)

When at the level of the mitral valve, the over-rotated image will show communication between the LV and LA. A true short axis at the level of the mitral valve will show the “fish mouth” appearance of the mitral valve