The causes of right ventricular enlargement have changed greatly in the past 20 years. The causes of right ventricular enlargement caused by congenital heart disease and rheumatic heart disease have decreased significantly, while right ventricular enlargement and pulmonary hypertension caused by myocardial lesions and valvular lesions have a tendency to increase gradually. Rheumatic heart disease is mostly caused by poor living conditions, malnutrition and damp and cold living places. With the development of social economy, the improvement of people’s living standards and living conditions, the incidence of rheumatic heart disease is becoming less and less, so the right ventricular enlargement and pulmonary hypertension caused by rheumatic heart disease are also gradually reduced. According to current research, right heart lesions are divided into three main categories: a. Simple right heart disease: including right ventricular myocardial densification insufficiency, arrhythmogenic right ventricular cardiomyopathy. Right ventricular myocardial densification insufficiency: a recently discovered and named congenital heart disease, characterized by a spongy right ventricular myocardium with a deep crypt in the right ventricular apex and cavity, which occurs due to early termination of myocardial densification during embryonic development. The clinical manifestations are mainly myocardial systolic dysfunction, thrombosis, arrhythmia, and sudden death. Arrhythmogenic right ventricular dysplastic cardiomyopathy: It is a rare hereditary cardiomyopathy, mainly characterized by progressive replacement of the right ventricular myocardium with fibrofatty tissue, resulting in partial or total involvement of the right ventricle, and the left ventricle is also involved in about 75% of patients. Second, pulmonary hypertension with right heart disease and right heart failure: including pulmonary hypertension, right heart disease with pulmonary hypertension; pulmonary disease, pulmonary heart disease, thromboembolic pulmonary hypertension, connective tissue disease with pulmonary hypertension, etc. Third, total heart disease or total heart failure: including dilated cardiomyopathy involving both the right and left heart, acute fulminant myocarditis, congenital heart disease with simultaneous involvement of the right and left ventricles. It is generally believed that 15-20% of patients with congenital heart disease are complicated by pulmonary hypertension. The incidence of pulmonary hypertension in patients with severe congenital heart disease or Eisenmenger’s syndrome is 4%, and the incidence of pulmonary hypertension in patients with non-operatively treated congenital heart disease is 30%, and in patients with surgically treated congenital heart disease is 15%. The prevalence of pulmonary hypertension due to connective tissue disease is 3.7-31.1%, most commonly in systemic sclerosis, mixed connective tissue disease, and systemic lupus erythematosus. Pulmonary hypertension due to left heart disease: (1) pulmonary hypertension due to systolic cardiac insufficiency; (2) pulmonary hypertension due to diastolic cardiac insufficiency; (3) pulmonary hypertension due to valvular disease. About 60% of patients with severe left ventricular systolic dysfunction and 70% of patients with left ventricular diastolic dysfunction can have pulmonary hypertension. In the past 20 years, pulmonary hypertension due to congenital heart disease has gradually decreased, while pulmonary hypertension due to cardiomyopathy and valvular disease has a significant trend of increase. For example, pulmonary hypertension occurs in 25% of patients with mild chronic obstructive pulmonary disease, 43% of patients with moderate disease, and 68% of patients with severe disease. Pulmonary hypertension due to chronic thrombotic disease accounts for 0.34% of hospitalized patients. The prevalence of severe pulmonary hypertension is low, but the prognosis is mostly poor. With the prevalence of hypertension, coronary artery disease, valvular lesions and chronic lung disease, the incidence of pulmonary hypertension due to left atrial disease, pulmonary disease or hypoxia has increased. Diagnosis of right heart enlargement and hypertrophy with cardiac ultrasound as the preferred and primary imaging test can evaluate the size of the right ventricle and right atrium, the magnitude of pulmonary artery pressure, and can evaluate right heart systolic function by tricuspid annular systolic shift, tricuspid annular pulsed Doppler maximum peak velocity, pulsed Doppler myocardial function index, tissue Doppler myocardial function index, FAC, and by tricuspid E/A, E/e and deceleration time DT to evaluate right heart diastolic function. Routine examination of electrocardiogram can detect right atrial and right ventricular hypertrophy, right bundle branch block, right ventricular myocardial infarction, and acute pulmonary embolism. Routine examination of a frontal and lateral chest radiograph can reveal right ventricular enlargement and pulmonary hypertension. Cardiac magnetic resonance imaging may be considered if the patient is too obese for ultrasound to show, or if the patient is suspected of having arrhythmogenic right ventricular cardiomyopathy or right ventricular myocardial densification insufficiency. Three-dimensional spatial imaging allows assessment of right heart function, right ventricular volume, right ventricular ejection fraction, evaluation of right and left ventricular chamber volumes, local ventricular wall motion, myocardial thickness and muscle weight, pericardial thickness, and masses. In case of pulmonary hypertension and right heart insufficiency, the following positive signs can be detected by physical examination, such as jugular venous pulsation or filling, positive hepatic jugular venous regurgitation sign, subxiphoid cardiac pulsation, splitting of the second heart sound in the pulmonary valve area, and bilateral lower extremity edema.