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

When evaluating a patient with suspected left ventricular (LV) systolic dysfunction, E-point septal separation (EPSS) provides a rapid, quantitative estimate of left ventricular ejection fraction. In the parasternal long-axis view using M-mode, EPSS is measured as the shortest distance between the anterior mitral valve leaflet at its maximal early diastolic excursion (E-point) and the interventricular septum. As LV systolic function declines, the mitral valve opens less widel

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

In the proper clinical setting, a dilated aortic root should raise suspicion for potentially life-threatening conditions such as acute type A aortic dissection. In the parasternal long-axis view, the normal aortic root is typically similar in diameter to both the left atrium and the right ventricle. An aortic root measuring > 4 cm by echocardiography is generally considered enlarged and serves as a practical screening threshold in the emergency setting. Although indexing to b

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