POCUS signs of right heart strain and failure include:
- RV dilation - RV should be < ~ 60% the size of LV.
- Septal flattening: "D-sign" best seen on PSAX. Diastolic flattening suggests volume overload, systolic flattening suggests pressure overload (eg PE or pulmonary hypertension)
- Decreased TAPSE Tricuspid Annular Plane Systolic Excursion is measured in M-mode in the A4C view tracking longitudinal movement of the tricuspid annulus. Less than <17mm suggests RV systolic dysfunction. (Apical 4-chamber)
- Decreased RV FAC Fractional Area Change is calculated by tracing the RV area in end-diastole and end-systole. A change of <35% suggests failure.
- McConnell’s Sign Distinctive regional wall motion abnormality where the RV mid-wall is akinetic, but apex is hyperdynamic. Often associated with acute Pulmonary Embolism.
- IVC Plethora IVC diameter over 2.1cm is dilated. A Caval Index <50% during inspiration (sniff test) suggests high central venous pressure (CVP), consistent with right-sided heart failure.
- TR often accompanies RV failure
PMID: 41994789 PMID: 29083579