Echocardiography Imaging Windows - The Apical 4 Chamber View

An Apical view  helps an echocardiographer to visualize all the 4 chambers  of the heart. For making this view the probe should be placed at the apex of the left ventricle. The marker or ridge of the probe is oriented towards the right shoulder blade of the patient. It is a good idea to abduct the patient`s left arm as it widens the intercostal spaces which as a result improves the view.

This view can help you to visualize  four chambers of the heart - (Left ventricle, left atrium, right ventricle and right atrium) and the  atrioventricular valves (Mitral and Tricuspid valves). The 4 chamber view also helps an echocardiographer to detect and grade tricuspid and mitral valve lesions, this can be easily done by using color flow imaging and doppler. One can also access size of the ventrilces, ejection fraction and pulmonary vein inflow for accesing diastolic function.






Some points to remember about apical 4 chamber view....

1. The right chambers are visualized on the left side of the screen and vice versa. 
2. The lateral wall of the left ventricle is on the right; the septal wall is in the center.
3. The size of the right ventricle should be about 2/3 of the Left ventricle. 
4. The function of the right ventricle can be evaluated by looking at the vertical motion of the lateral tricuspid annulus. The right ventricle usually contracts in the longitudinal manner.
5. Tricuspid valve is few millimeters towards the apex as compared to the Mitral valve.