What am I Looking at?

The subxiphoid 4 Chamber view can be used to assess ventricular function, particularly during emergent situations, when access to the other windows is limited.

The left ventricle is seen in the far field with the septal and lateral walls in view. The RV is seen more anteriorly.

 

Figure 25. Subxiphoid 4 chamber with the LV walls labeled

What is Normal

Contractility:

All visible LV walls should demonstrate symmetric inward motion and thickening, moving toward the center of the ventricle in a coordinated fashion.

Figure 26. Subxiphoid 4 chamber view with normal LV function

 

What is NOT Normal

Decreased global function:

The LV walls will fail to contract effectively toward the center of the cavity during systole. Wall motion appears sluggish or diminished, and the overall inward movement and thickening are reduced (figure 27).

Figure 27: Subxiphoid 4 Chamber demonstrating reduced LV systolic function. Video courtesy of Dave Kirschner