Recognizing Acute Right Heart Strain with POCUS: The D-Sign in Pulmonary Embolism

A 41-year-old woman presents to the emergency department with a sudden onset of dyspnea and pleuritic chest pain for two hours. She appears mildly anxious and diaphoretic. She denies fever, cough, trauma, or recent illness. She takes oral contraceptives and has no significant past medical history.

Vital signs reveal HR 113 bpm, RR 24, O₂ saturation 94% on room air, and BP 110/74 mmHg.

Her lung exam is clear. Cardiac exam reveals tachycardia without murmurs.