The D-sign: Right Ventricular Strain


This is a parasternal short axis view in a patient with extensive pulmonary emboli on CTA. The troponin was mildly elevated and patient hemodynamically stable. A bedside echo revealed evidence of RV strain (note the “D” shaped left ventricle). Image courtesy of: Therese Mead, DO, Emergency Physician


Echocardiography can be a useful adjunct to laboratory markers (i.e. BNP and troponin) and CTA for evaluation of right heart strain.  The most up-to-date evidence supports that emergency physicians can accurately perform echocardiography at the bedside to risk stratify patients presenting with concern for pulmonary embolism.

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Article: Diagnostic Accuracy of Right Ventricular Dysfunction Markers in Normotensive Emergency Department Patients With Acute Pulmonary Embolism

Article: Interobserver and Intraobserver Agreement on Qualitative Assessments of Right Ventricular Dysfunction With Echocardiography in Patients With Pulmonary Embolism

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