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ECHOCARDIOGRAPHY VIEWS
Main Imaging Windows
1- Parasternal window
2- Apical window
3- Subcostal / Subxyphoid window
Parasternal Long Axis
Generally the first view obtained in a routine transthoracic echocardiogram. It is the standard
view for making M-mode and 2D measurements of the left ventricle, estimate size &
contractility of the right and left ventricle (septum and posterior wall), and to assess
morphology and function of the mitral and aortic valves. aortic root and left atrium. The patient
is best imaged lying on their left side, with their left arm under their head. With color Doppler
you can assess for aortic or mitral regurgitation. In the appropriate standard view the apex is
not visible. The left ventricle is oriented almost horizontally.
Parasternal Short Axis
3 levels of imaging the heart in short axis:
 Base of the heart, level of the aortic valve
 Level of the mitral valve
 Mid-ventricle: papillary muscles & towards apex
This position encompasses several different views of
the LV in short axis that differ in how basal or apical
the probe is. The most basal window lays out the
aortic valve, pulmonic valve, and tricuspid valve.
Other standard views include the LV at the mitral
valve level, the mid ventricle level and apex all shown
sequentially below.
Short Axis Tricuspid & Pulmonic Valve
View
Apical
Place probe at point of maximal impulse. There are
numerous views that obtained from this position
including 4 chamber view, 5 chamber view (includes LV
outflow tract), the 2 chamber view and the apical long
axis view (“3 chamber view”) all by rotation and minor
manipulation of the probe. Most useful for:
 Assessing flow across aortic, tricuspid and mitral
valves with Doppler.
 Assessment of diastolic function, including use of
tissue Doppler and pulsing across the pulmonary
veins.
 Assessment of RV size and function including use of
tricuspid annular plane systolic excursion (TAPSE)
 Evaluation of LV segmental wall motion and of LV
thrombus sometimes with an IV echo contrast agent.
 Assessment for a PFO or ASD in conjunction with the
use of saline contrast
Apical 4 Chamber
Can visualize the 4 main chambers of the heart: left
ventricle and atrium, right ventricle and atrium. Best view
to calculate the ejection fraction, to visualize the apex of
the left ventricle, and to study the mitral inflow (diastolic
function and mitral stenosis)
Short Axis Pulmonary Artery View
Apical 5 Chamber
Differs from apical 4 chamber view by presence of
the aortic valve in the center of the image. By tilting
the head of the probe upwards you move to more
anterior structures and create the apical 5 chamber
position, the LVOT, aortic valve and proximal aorta
can be seen. This is the view with the best
alignment of the Doppler beam with the aortic
outflow tract, to look and grade an aortic stenosis
and to calculate the cardiac output.
Apical Long Axis
This view shows similar structures to the parasternal
long axis except now the LV apex is well visualized
and is in the near field.
Subcostal 4 Chamber
Excellent for looking at the anterior RV free wall, assess for RV thickness, and for evaluation of
pericardial effusions. Useful views for evaluating flow across the intra-atrial septum for the
presence of a PFO or ASD. Scan under the subxyphoid process until a standard 4 chamber view
obtained; increasing depth is usually needed depending on how high up the heart is located.
Inferior Vena Cava
Determination of IVC diameter and respiratory
variations can be used for the estimation of a
patient's volume status.