Pulmonary hypertension and right heart failure (RHF) in SSc. Pulmonary hypertension and RHF in SSc. (A) Apical four-chamber echocardiogram demonstrates severe right atrial and ventricular enlargement with moderate-severe tricuspid regurgitation. (B) Continuous wave Doppler across the tricuspid jet demonstrates right ventricular systolic pressure 76 mmHg, which is consistent with severe pulmonary hypertension when added to the right atrial pressure. Cardiac magnetic resonance image in systole (C) and diastole (D) dilated right ventricle with flattening of the interventricular septum and impaired function (right ventricular ejection fraction 30%).