Pearls for RV strain on ECHO, as demonstrated by Dr. Levy’s case:

1. A parasternal short axis and 4 chamber are good views to evaluate for signs of RV dilation

2. A D sign results from increased pressure in the right side, flattening the septum towards the LV:

3. The apex of the RV should be lower than the LV in the 4 chamber, when it is not, this is a sign of enlargement

4. McConnells sign is specific (97%), but not sensitive (22%) for a PE.  LR+ 7.33.  Note the lack of movement of the RV free wall, but preserved function of the apex. This creates the “tramponline” like effect:

 5. Adding a DVT study can clinch the diagnosis since majority of PE’s break off from DVTs, so take a quick look! Here is the clot for this case:

Want more? Check out this ACEP article by our own Dr. Tozer and Dr. Morrison: