Cardiac: Apical 4-Chamber

1. 1

   Position patient in left lateral decubitus — this is essential for a non-foreshortened apex.

2. 2

   Locate the cardiac apex by palpation or 2D guidance. Place probe at the point of maximal impulse.

3. 3

   Orient marker toward the left shoulder. The LV should appear on the right of screen, RV on the left.

4. 4

   Optimize until all four chambers are visible and the apex is at the top of the sector.

5. 5

   Assess LV and RV size, wall motion in all visible segments, and gross EF visually.

6. 6

   Evaluate mitral and tricuspid valves for regurgitation with color Doppler.

7. 7

   Ensure the apex is not foreshortened — the LV should taper to a true point, not a flat wall.

• Apical 4-Chamber (A4C)

• All 4 chambers
• MV and TV function
• Apical wall motion
• EF (visual/biplane)

• Foreshortened apex gives falsely elevated EF
• Patient positioning critical (left lateral decubitus)

Position patient in left lateral decubitus. Probe at cardiac apex, marker toward left shoulder.