McConnell’s Sign

McConnell’s sign is an echocardiographic finding classically described as akinesis of the right ventricle’s (RV) mid-free wall with preserved apical contractility on echocardiography. It’s often associated with acute pulmonary embolism (PE) and is thought to reflect regional wall motion abnormalities from acute RV pressure overload and tethering of the apex to a hyperdynamic LV.

While initially described as being specific for PE, this sign can also be seen in other causes of acute RV dysfunction (e.g., RV infarction and pulmonary hypertension exacerbations). In these cases, regional variation in RV contractility may reflect differences in perfusion, geometry, and pericardial constraint rather than an etiology-specific pathognomonic feature.

With that said, seeing McConnell’s sign in a patient with hypotension, elevated central venous pressures, and sudden-onset hypoxia should prompt consideration of a massive/submassive PE and expedite further workup.

In this apical 4-chamber POCUS video (credit to Dr. Akshay Chaku, MD), the RV apex (encircled in yellow) continues to contract. At the same time, the free wall is hypo/akinetic.