I'm oron Frankel an Emergency Physician to generate the apical four chamber view it's critical that I get a good orientation of the heart but it can provide critical information on chamber orientation and function to get that view I'm using a phased array transducer here and I'm coming in at an oblique angle usually at about the fourth or fifth intercostal space midcavicular line and I like to think of it as a spear coming up from the apex of the heart towards the patient's right shoulder from here I'll have to do some micro movements kind of like a tic-tac-toe board up down and to the side really trying to optimize my window of the heart once I see the heart where I want it I'll try and line up those ventricles vertical as possible by tilting the transducer and maybe sliding it to get them right in the middle of the screen it's really critical that I don't foreshorten the ventricles meaning that I get them at their longest possible view I can generate once I'm happy with that and I've got all four chambers in view this is where I can do pulse wave Doppler and color assessments of the valves and make estimations of the left ventricular function and compare it to the right ventricular function as well
