Some, all or none of the following findings may be present.
BNP: Elevated
ECG findings (similar to acute pulmonary embolism):
Right axis deviation
Evidence of right heart strain on bedside ultrasound or CT
S1Q3T3 ECG finding
Twave inversions on ECG in inferior and anteroseptal leads
Right ventricular hypertrophy
Large R waves in precordial leads
Tachyarrhythmias (atrial flutter or atrial fibrillation if new portend poorer prognosis)
Right axis deviation
Evidence of right heart strain on bedside ultrasound or CT
S1Q3T3 ECG finding
Twave inversions on ECG in inferior and anteroseptal leads
Right ventricular hypertrophy
RA enlargement (obliteration of retrosternal space on lateral CXR)
Prominent pulmonary vasculature (congestion)
PA dilation
RA enlargement (obliteration of retrosternal space on lateral CXR)
Prominent pulmonary vasculature (congestion)
PA dilation
Pulmonary artery > ascending aorta suggests<unk> 
Pulmonary artery diameter greater than 30 mm suggest<unk> 
Right heart enlargement
D sign (McConnel's Sign)
RV close to LV size (+/- septal flattening/bowing)
Tricuspid valve regurgitation
Estimate systolic pulmonary artery pressure (SPAP) with echo
SPAP = Max TR gradient + Mean RAP
Cannot use this method with vent-dependent patients, pulmonic stenosis
Max TR gradient as measured by tricuspid regurgitation (TR) jet, which >90% of adults have
Use parallel CW Doppler line across TR jet in apical view
Obtain dense TR profile below the line with well-defined envelope and measure peak = Max TR gradient
Estimate right atrial pressure (RAP) with IVC diameter from subcostal view
SPAP = Max TR gradient + Mean RAP
Cannot use this method with vent-dependent patients, pulmonic stenosis
Max TR gradient as measured by tricuspid regurgitation (TR) jet, which >90% of adults have
Use parallel CW Doppler line across TR jet in apical view
Obtain dense TR profile below the line with well-defined envelope and measure peak = Max TR gradient
Estimate right atrial pressure (RAP) with IVC diameter from subcostal view
Initial diagnosis not typically made in the ED because right-sided heart catheterization needed for definitive diagnosis
Pulmonary hypertension
Pulmonary
Bronchopulmonary dysplasia
Airway obstruction
Empyema
Anaphylaxis
Pneumoconiosis
Angioedema