Right Ventricle


Visual assessment of all 4 windows, but the short axis and apical 4-most important

Assessment of the IVC and IJs additive information

  • If RV dysfunctional may indicate volume overload
  • Ventilator can cause same effect with normal RV function

Short axis

  • Septal flattening and D-shaped LV
  • Enlarged RV
  • Best seen at the papillary level

Apical 4

  • Enlargement of the RV relative to the LV
  • The RV should be 1/3 the LV
  • Maybe closer to equal in intubated patients
  • Anterior motion of the RV at the tricuspid valve
  • Basis of TAPSE, but can be assessed visually


Graded as normal function or mild, moderate and severe dysfunction


Do not overthink; it will become intuitive quickly

Think of it is as: Fine, not great and terrible

Make sure to use cardiac exam or presets. If using abdominal imaging the heart will look dysfunctional

If the RV is foreshortened (looks more like a softball then a football) it may look dysfunctional when function is normal

Figures and Clips

Figure 1 - RV Enlargement

Clip 1 - Normal RV, PSL View

Clip 2 - Severe RV dysfunction, PSL View

Clip 3 - RV enlargement, PSL View

Clip 4 - Normal RV, PSS View

Clip 5 - D shaped LV, PSS View

Clip 6 - Normal, A4C View

Clip 7 - Severe RV Dysfunction, A4C View

Clip 8 - Biventricular Dysfunction, A4C View


Lang, Roberto M., et al. “Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.” European Heart Journal-Cardiovascular Imaging 16.3 (2015): 233-271.