Apical 4-chamber view

With the apical 4-chamber view, the following structures can be visualized:

• All 4 chambers (left and right ventricles, left and right atria),

• the septal and lateral walls of the left ventricle,

• the mitral and tricuspid valves.

With this projection, you can assess:

• left ventricular systolic function, as well as regional wall motion abnormalities,

• size of the left/right ventricle and left/right atrium (both visual estimation, as well as measuring with Simpson’s biplane, on the left heart),

• morphology of the mitral valve,

• visual estimation of the systolic function of the right ventricle.

There are also additional measurements you can obtain with this projection.

If you place a color or continuous Doppler over the mitral valve, you can assess its function.

If you place a color Doppler and continuous Doppler over the tricuspid valve, you can assess its function.

If you manage to measure the velocity of a tricuspid regurgitation, you can estimate the RV/RA (right ventricular to right atrial) pressure gradient.

You can assess the diastolic function of the left ventricle if you measure the E/A wave by placing a pulsed Doppler at the tip of the mitral valve and measure the S/D wave by placing a pulsed Doppler over a pulmonary vein. You will also need to measure the e´ waves (which represent the tricuspid annular early diastolic velocity) in basal regions of the septal and lateral ventricle walls by placing a tissue Doppler there.

You can measure the systolic function of the right ventricle by measuring TAPSE (Tricuspid annular plane systolic excursion), this is done by placing an M-Mode (motion mode) through the base of the right ventricle free wall.

Another way of measuring the systolic function of the right ventricle is by measuring s´(which represents systolic velocity), this is done by placing a Tissue Doppler at the base of the right ventricle free wall.