Many providers learn point-of-care echo with the motivation to identify right heart strain (cor pulmonale). This finding, after all, may be evidence of the frustrating diagnosis of pulmonary embolism and offers the bedside provider a tool to alter their pre-test probability of the disease and triage its severity (“sub massive”) when already diagnosed. A wrinkle in this plan for a better bedside tool kit in the fight against VTE is the fact that many patients have chronic conditions that continuously challenge their right heart. These patients come in with a priori echo findings – but how are you to know? How should this influence your plans for work-up and management in the dyspneic patient? Well you can start by watching the screencast below by one of our critical care ultrasound fellows, Dr. Hatem Salim who faced this issue more than once in his month with us.