Apical Four Chamber

Ok, almost there! The Apical Four Chamber View is a fantastically rewarding view, when you can get a great image. For this view you will need to have the patient roll onto their left hip to swing the heart closer to the chest wall (incidentally, this helps with the parasternal views as well if you're not getting a great image). So now that they're rolled over, place your probe just below the patient's nipple (or in women, under the breast) and aim toward the RIGHT shoulder with your beam. The probe marker should be pointed to the patient's LEFT shoulder. This view takes quite a bit of fishing but here's the idea:


Here's the position you'd like to imitate (remember, probe marker to the patient's LEFT shoulder and aim your US beam to the RIGHT shoulder!

And here's what you'll see on the screen:

1. Left side of the heart on the Right side of the screen

2. Ventricles ALWAYS at the top of the screen

3. Mitral and Tricuspid valves (hint: if you're confused what is the right side of the heart vs. left, a quick and dirty way to figure it out is that the tricuspid valve inserts on the septum slightly lower (higher on the screen) than the mitral valve; and, of course the LV is usually thicker...but be careful, the rotational angle of your probe can affect the size/thickness of the chambers on the monitor!)

You did it. Now go practice and grab me at any time for help!

Good Luck!

Hunter Louis, MD
Ultrasound Fellow
Palmetto Health Richland
Columbia, SC

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