Compare RV and LV size in the apical four-chamber view, look for septal flattening, measure TAPSE, and interpret signs of acute (thin-walled, McConnell sign) vs chronic (hypertrophied) RV overload.
At the bedside
Timed steps- 1
RV:LV ratio
SizeApical four-chamber: RV basal diameter > 41 mm or RV:LV > 1.0 indicates dilatation.
- 2
Septum
ShapePSAX D-sign: diastolic flattening = volume overload; systolic flattening = pressure overload.
- 3
TAPSE
FunctionM-mode through lateral tricuspid annulus: < 17 mm = RV dysfunction.
- 4
Wall thickness
Acute vs chronicRV free wall > 5 mm suggests chronic pressure overload (pulmonary hypertension); thin dilated RV with McConnell sign (apical sparing) suggests acute PE.
- 5
Ventilation
ContextHigh PEEP, hypercapnia and hypoxaemia worsen RV afterload in ARDS (acute cor pulmonale).
References
- 1
- 2
Is the RV in trouble?
Step 1 of ~3
Decision: RV:LV > 1 or RV basal > 41 mm?
Based on Rudski LG, Lai WW, Afilalo J, et al. Educational use; follow local protocol.
Evidence
- ASE right-heart guideline 2010: reference values (RV basal diameter > 42 mm abnormal in that document's tables, TAPSE < 16 mm abnormal; later ASE/EACVI chamber quantification updated to > 41 mm and < 17 mm).
🇮🇳 India notes
- Chronic thromboembolic disease and post-TB lung disease are common causes of chronic RV hypertrophy in India.
References
- 1
- 2
Test yourself
Module quiz · score 70% to complete the module
Educational reference for trained clinicians. Check doses against your hospital protocol and the patient in front of you.