@echovault_sd: A D-shaped LV is a classic echocardiographic sign of right ventricular (RV) pressure or volume overload. While it may look like an LV abnormality, the problem actually originates on the right side of the heart. Normally, the LV appears round in the parasternal short-axis (PSAX) view because it generates much higher pressure than the RV. This pressure difference keeps the interventricular septum gently curved toward the RV. When the RV is exposed to abnormally high pressure or excessive volume, it pushes the interventricular septum toward the LV. This flattens the septum, causing the LV to lose its circular shape and appear like the letter “D.” 🫀Pressure Overload Conditions such as pulmonary hypertension, pulmonary embolism, or pulmonic stenosis increase the resistance the RV must pump against. As RV pressure rises during systole, the septum shifts leftward, producing a D-shaped LV during systole. 🫀Volume Overload A D-shaped LV is a classic echocardiographic sign of right ventricular (RV) pressure or volume overload. While it may look like an LV abnormality, the problem actually originates on the right side of the heart. Normally, the LV appears round in the parasternal short-axis (PSAX) view because it generates much higher pressure than the RV. This pressure difference keeps the interventricular septum gently curved toward the RV. When the RV is exposed to abnormally high pressure or excessive volume, it pushes the interventricular septum toward the LV. This flattens the septum, causing the LV to lose its circular shape and appear like the letter “D.” 🫀Pressure Overload Conditions such as pulmonary hypertension, pulmonary embolism, or pulmonic stenosis increase the resistance the RV must pump against. As RV pressure rises during systole, the septum shifts leftward, producing a D-shaped LV during systole. 🫀Volume Overload Conditions like severe tricuspid regurgitation, pulmonary regurgitation, or an atrial septal defect (ASD) cause the RV to fill with excess blood. During diastole, the enlarged RV pushes the septum toward the LV, creating a D-shaped LV during ventricular filling. 📍How to identify it on echocardiography Obtain the parasternal short-axis view at the papillary muscle level. A normal LV should appear perfectly round. A flattened interventricular septum resulting in a D-shaped LV should immediately prompt a thorough assessment of the right ventricle. Don’t stop at recognizing the D-shape. Evaluate: ✔️ RV size and wall thickness ✔️ RV systolic function (TAPSE, RV S’, FAC) ✔️ Tricuspid regurgitation velocity (to estimate pulmonary pressures) ✔️ IVC size and respiratory collapse ✔️ Right atrial enlargement and other signs of Conditions like severe tricuspid regurgitation, pulmonary regurgitation, or an atrial septal defect (ASD) cause the RV to fill with excess blood. During diastole, the enlarged RV pushes the septum toward the LV, creating a D-shaped LV during ventricular filling. 📍How to identify it on echocardiography: Obtain the parasternal short-axis view at the papillary muscle level. A normal LV should appear perfectly round. A flattened interventricular septum resulting in a D-shaped LV should immediately prompt a thorough assessment of the right ventricle. Don’t stop at recognizing the D-shape. Evaluate: 🫀RV size and wall thickness 🫀RV systolic function (TAPSE, RV S’, FAC) 🫀Tricuspid regurgitation velocity (to estimate pulmonary pressures) 🫀IVC size and respiratory collapse 🫀Right atrial enlargement and other signs of elevated right-sided pressures 🩺 🫀: A D-shaped LV is not a diagnosis it’s an important clue that the RV is under abnormal stress. Identifying when the septum flattens helps determine the cause: * Pressure overload → D-shape during systole * Volume overload → D-shape during diastole Understanding this concept is essential because recognizing a D-shaped LV can be the first step in diagnosing serious conditions such as pulmonary hypertension, acute pulmonary embolism, or significant right sided valvular disease. #echo

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Tuesday 30 June 2026 00:10:46 GMT