About 70 y old patient with chronic dyspnoea, permanent atrial fibrillation (CHADS-Vasc-Scor 5), actually deterioration of clinical afflictions. A COPD is kown (stage III GOLD)
In TTE and TEE we ccould see a distinct RV-hypertrophy with systolic and diastolic septal bounce (D-sign) as a sign for RV-volume overload and RV-pressure overload (PAPsystolic about 70 mmHg + CVP). In LAA you can see a distinct echocantrast (thrombus?).
An another interesting finding is a PFO with right-to-left-shunt.