Standard transthoracic echo views

The 14 standard TTE views: where the probe goes, what you see and what to measure in each.

Parasternal long axis

Left sternal edge, 3rd–4th intercostal space; marker towards the right shoulder.

IVSd, LVIDd, PWd, LVIDs · LVOT diameter · Aortic root (4 levels) · LA AP diameter · MR/AR colour

RV inflow

From PLAX tilt the tail of the probe towards the left shoulder (beam to the right hip).

TR colour and CW (often best aligned here) · TV morphology

Short axis — aortic valve

From PLAX rotate 90° clockwise; marker towards the left shoulder; tilt up to the base.

AV morphology (bicuspid?) · RVOT diameter & VTI · PA acceleration time · Qp:Qs

Short axis — mitral valve

Tilt inferiorly from the aortic valve level.

MV planimetry (MS) · Commissural fusion · Basal wall motion

Short axis — papillary muscles

Tilt further towards the apex until both papillary muscles are seen.

Mid-segment wall motion · LV eccentricity index · Septal shape (D-sign)

Short axis — apex

Tilt inferiorly until the RV is no longer seen.

Apical wall motion · Apical hypertrophy, thrombus, aneurysm

Apical four-chamber

Apex beat; marker at 3 o’clock (towards the left axilla).

Biplane volumes & EF · LA/RA volume · Mitral inflow, e′ · TR velocity · GLS

RV-focused apical four-chamber

From A4C rotate and slide laterally until the RV is widest with the LV apex still in view.

RVD1 / RVD2 / RVD3 · TAPSE, RV S′ · FAC · RV free-wall strain

Apical five-chamber

From A4C tilt anteriorly to open the LVOT.

LVOT VTI (PW) · AV Vmax, MG, VTI (CW) · AR jet, PHT · IVRT

Apical two-chamber

From A4C rotate ≈60° counter-clockwise until the RV disappears.

Second plane for biplane volumes and LA volume · Wall motion

Apical three-chamber

From A2C rotate a further ≈60° counter-clockwise until the LVOT and aorta open.

Wall motion · LVOT/AV Doppler if A5C suboptimal · GLS

Subcostal four-chamber

Below the xiphoid, marker to the patient’s left, probe flat.

RV wall thickness · Effusion · ASD colour flow

Subcostal IVC

From SC4C rotate 90° counter-clockwise (marker to the head).

IVC diameter & collapse → RAP · Hepatic vein Doppler

Suprasternal notch

In the notch, marker towards 1 o’clock, neck extended.

Descending aortic flow reversal (AR) · Coarctation gradient · Arch diameter