𝐇𝐨𝐰 𝐭𝐨 𝐄𝐬𝐭𝐢𝐦𝐚𝐭𝐞 𝐏𝐮𝐥𝐦𝐨𝐧𝐚𝐫𝐲 𝐇𝐲𝐩𝐞𝐫𝐭𝐞𝐧𝐬𝐢𝐨𝐧 𝐨𝐧 𝐄𝐜𝐡𝐨𝐜𝐚𝐫𝐝𝐢𝐨𝐠𝐫𝐚𝐩𝐡𝐲

To the point guide to check Pulmonary Hypertension (PH) / estimate PASP on Echo and how to report it 👇

🩺 Key Steps to Estimate Pulmonary Artery Systolic Pressure (PASP)

1. Get TR Jet (Tricuspid Regurgitation) Velocity

Use apical 4-chamber or RV inflow view.

Apply continuous-wave Doppler through TR jet.

Optimize alignment with jet for peak TR velocity (V) in m/s.

2. Apply Bernoulli Equation

Pressure gradient (ΔP) = 4 × (V)²

→ e.g. if TR velocity = 3.2 m/s → ΔP = 4 × (3.2)² = 41 mmHg

3. Estimate Right Atrial Pressure (RAP)

Use IVC size and collapse on subcostal view:

IVC < 2.1 cm and collapses > 50% → RAP = 3 mmHg

IVC > 2.1 cm and collapses < 50% → RAP = 15 mmHg

Intermediate → RAP = 8 mmHg

4. Calculate PASP

PASP = 4(V²) + RAP

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📊 Interpretation (Adults)

PASP (mmHg) Interpretation

< 30 Normal

30–40 Mild PH

41–55 Moderate PH

> 55 Severe PH

(Assuming no pulmonic stenosis or RVOT obstruction.)

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🧾 Reporting Template

Findings:

Peak TR velocity: ___ m/s

Estimated RV-RA gradient: ___ mmHg

IVC diameter: ___ cm, collapse ___ % → RAP = ___ mmHg

Estimated PASP = ___ mmHg

Impression:

Pulmonary artery systolic pressure is [normal/mildly/moderately/severely elevated], consistent with [no / mild / moderate / severe] pulmonary hypertension.