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.
Learn more
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
