about 90 y old patient with sudden drop down without dyspnoea but hypotension, tachycardia. In TTE I could visualize that echocardiographic picture of RV-ballooning with D-sign of LV. New high grade tricuspid valve insufficiency (PAPs ca. 40 mmHg + CVP) in comparison with prior echocardiographic results. Unfortunately the patient had also a fracture of the right leg with bleeding complication caused by the drop.