Skip to Main Content

Technique

  • The transducer indicator is directed toward the left axilla or directly posterior to the patient.

  • The transducer is placed over the cardiac apex or the point of maximal intensity with the beam directed toward the right clavicle/shoulder in a plane coronal to the heart (Fig. 24.41).

  • Identify the left ventricle, right ventricle, left atrium, right atrium, tricuspid valve, mitral valve, and surrounding pericardium (Fig. 24.42).

FIGURE 24.41

Apical Four-Chamber View. The transducer is placed over the cardiac apex with the beam directed toward the right clavicle/shoulder in a plane coronal to the heart. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 24.42

Apical Four-Chamber View. The left ventricle, right ventricle, left atrium, right atrium, and tricuspid and mitral valves are seen. (Ultrasound contributor: Jeremy S. Boyd, MD; Illustration contributor: Robinson M. Ferre, MD.)

Abnormal Findings

  • Pericardial effusion: Anechoic (black) region noted between the hyperechoic pericardium and the walls of the heart (see Figs. 24.37 and 24.43).

  • Dilated right atria/ventricle: If the right ventricle is equal to or larger than the left ventricle in size, or there is poor contractility of the right heart in comparison with the left, it may suggest elevated right-sided pressures as seen with pulmonary emboli and severe pulmonary hypertension (Fig. 24.44).

  • Dilated cardiomyopathy: As cardiac remodeling occurs in states of dilated cardiomyopathy, the left ventricle begins to take on more of a dilated balloon-like shape rather than its normal more streamlined bullet-like shape (Fig 24.45).

FIGURE 24.43

Apical Four-Chamber View. A pericardial effusion appears as an anechoic (black) region between the hyperechoic pericardium and the walls of the heart. When tamponade physiology is present, right atrial and right ventricular collapse may be seen. Right atrial collapse is seen in the ultrasound image. (Illustration contributor: Robinson M. Ferre, MD; ultrasound contributor: Jeremy S. Boyd, MD.)

Vedio Graphic Jump Location
Video 24-16: Apical Four-Chamber View
image
Play Video
Vedio Graphic Jump Location
Video 24-17: Apical Four-Chamber View: Pericardial Effusion
image
Play Video
Vedio Graphic Jump Location
Video 24-18: Apical Four-Chamber View: Dilated RV
image
Play Video
Vedio Graphic Jump Location
Video 24-19: Apical Four-Chamber View: Cardiomyopathy
image
Play Video
FIGURE 24.44

Apical Four-Chamber View. A right ventricle that is equal in size or larger than the left ventricle suggests elevated right-sided pressures. (Illustration contributor: Robinson M. Ferre, MD; ultrasound contributor: Robinson M. ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.