While we often think of the pericardium as a protective sac, it’s so much more than that. Under normal conditions, it moves and stretches with every heartbeat, quietly accommodating changes in volume and pressure.  But when it loses that flexibility, the pericardium can transmit pressure back to the heart or even restrict its ability to fill.  And that’s where the pericardial spectrum begins. A continuum that ranges from simple effusion to hemodynamic tamponade and, in chronic or recurrent inflammation, to constriction. Understanding this progression changes the way we view the pericardium and how we interpret our echo findings.

The concept of RV–PA coupling and uncoupling can sound intimidating, but it’s really about how well the right ventricle (RV) and the pulmonary arteries “work together”. Coupling is the measure of teamwork between the right ventricle and the pulmonary circulation—how efficiently the RV converts its contraction into blood flow through the lungs.

In this article, we’ll explain how to differentiate adaptive vs maladaptive right-ventricular remodeling in pulmonary hypertension using echocardiography, highlighting key imaging features, physiologic differences, and what each pattern means clinically.

In this article, we’ll focus specifically on the RV basal diameter measurement, explore the new severity grading, and discuss the prognostic value of this updated approach to evaluating RV size.

Few measurements in echo are as quick and powerful as the S′ velocity. With a single tissue Doppler tracing of the tricuspid annulus, we can quickly gauge whether the right ventricle is pulling its weight. 

In echocardiography, Fractional Area Change (FAC) is one of the most reliable 2D measures of right ventricular (RV) systolic function, offering a comprehensive view of right ventricular performance.