A patient is rushed into the resuscitation bay with acute onset dyspnea, hypoxia (that improves with supplemental oxygen) and tachycardia. Blood pressure is 111/74 mm/hg. No chest pain. Lungs are clear with A line pattern bilaterally. POCUS cardiac apical 4 chamber shows right ventricular dilation, and a positive McConnell’s sign (Clip 1). CT angio pulmonary embolism confirmed the diagnosis of PE. Tricuspid Annular Plane Systolic Excursion (TAPSE) is a measure of right heart function that can be used like troponin and brain natriuretic peptide to risk stratify patients with PE’s. An m-mode tracing is placed on the tricuspid annulus and you measure the displacement of that annulus as it moves during systole and diastole (Image 1-3). The distance is represented in a sine wave and you measure peak to trough. Normal is greater than 1.7cm. In this study (Lobo et al.) of normotensive patients with diagnosed PE’s, TAPSE was the only independent predictor of mortality.
Clip 1: Apical 4 chamber with dilated right ventricle and positive McConnell’s sign.
Image 1: First TAPSE measurement of 1.2 cm.
Image 2: Second TAPSE measurement of 1.3 cm.
Image 3: Third TAPSE measurement of 1.2 cm.