Accurate measurement of right ventricular free wall thickness (RVFWT) requires careful image optimization. Decrease the imaging depth and position the RV free wall near the center of the screen, with the focal zone at the level of the wall. Because ultrasound provides superior spatial resolution in the axial plane, orient the free wall horizontally so that the calipers measure perpendicular to the wall. Measure RVFWT at end-diastole, when the RV is largest and the relaxed fre

Intracardiac thrombus can develop rapidly during cardiac arrest as a consequence of the low-flow state. In one study, new thrombus formation was observed approximately 6 minutes after the onset of cardiac arrest. Therefore, identifying a right-sided thrombus during resuscitation does not always mean that pulmonary embolism (PE) caused the arrest—particularly when the finding appears later in the resuscitation or after prolonged downtime. Nevertheless, a clot-in-transit with a

In patients with acute pulmonary embolism, echocardiographic right ventricular enlargement is associated with an increased risk of in-hospital shock, cardiopulmonary resuscitation, and mortality. Recognizing RV enlargement at the bedside can therefore provide valuable prognostic information and help identify patients who may require closer monitoring, more aggressive therapy, or escalation of care. Reference: 📖 Alerhand S, Adrian RJ. What echocardiographic findings different

Tricuspid annular plane systolic excursion (TAPSE) is a simple, reproducible quantitative measure of longitudinal right ventricular (RV) systolic function. In the RV-focused apical 4-chamber view, TAPSE is measured using M-mode as the vertical displacement of the lateral tricuspid annulus from end-diastole to end-systole. Because the RV's deep subendocardial fibers are oriented longitudinally, this motion accounts for approximately 80% of RV stroke volume. Greater systolic de

An inaccurately aligned Doppler beam can underestimate the tricuspid regurgitation velocity (TRV) and, consequently, the estimated pulmonary artery systolic pressure (PASP). To maximize accuracy, interrogate the TR jet from multiple acoustic windows—including the right ventricular inflow, parasternal short-axis (aortic valve level), apical 4-chamber, subxiphoid long-axis, and subxiphoid short-axis (aortic valve level) views—and use the view with the most parallel alignment. I

Originally described in 1996, McConnell's sign is an additional adjunct finding that can further raise suspicion for acute pulmonary embolism in the appropriate clinical setting. It is characterized by diffuse hypokinesis of the right ventricular (RV) free wall with preserved contraction of the RV apex. Several mechanisms have been proposed to explain this finding: 1) Mechanical tethering of the RV apex to the hyperdynamic left ventricle 2) Acute changes in RV geometry that p

Not every intracardiac mass has the same appearance on echocardiography. A right heart thrombus (RHT) typically appears as a long, thin, highly mobile, free-floating "worm-like" mass that may prolapse through the tricuspid or pulmonic valve during the cardiac cycle. In contrast, vegetations are irregular, oscillating masses attached to the valve or to prosthetic material. Cardiac tumors generally demonstrate a broad-based attachment to the chamber wall or valve and may be ass