PA 65 originates at a triangular-shaped interchange at the I-279/US 19 Truck concurrency near downtown Pittsburgh. Long ramps stretch from exit 7A on I-279 north of the Fort Duquesne Bridge. PA 65 starts as a limited-access highway known as the "Ohio River Boulevard". This was the site of many deadly accidents during the 1970s. The following exit is called "North Shore" and is located only on PA 65 northbound. This exit is the primary entrance to Heinz Field (home to the Steelers) and it is also a way for drivers to get to PNC Park (home to the Pirates).