Transthoracic echocardiography (TTE) should be done as an initial test for individuals suspected of having pulmonary hypertension (PH). If the peak tricuspid regurgitation (TR) velocity is above 2.8 m/s and/or if secondary signs of pulmonary hypertension are present, further investigation should be considered. Normal pulmonary artery systolic pressure values vary with age and body mass index. Systolic, diastolic and mean pulmonary artery pressures can be evaluated through tricuspid regurgitation, pulmonary regurgitation, ventricular septal defect flow and right ventricular outflow tract acceleration time. A pre- versus post-capillary etiology for pulmonary hypertension can be determined by evaluating pulmonary vascular resistance (PVR), left ventricular (LV) systolic and diastolic function, left atrial size, left-sided valvular heart disease, right ventricular (RV) size and shape, RV-to-LV dimension, presence of pericardial effusion and by using a scoring system such as Opotowsky’s simplified clinical prediction score, D’Alto’s criteria or Vaidya’s Virtual Echocardiography Screening Tool. The right ventricle is a structure with a unique geometry which makes it more challenging to image. Therefore, RV function should be evaluated by using multiple views showing its different segments using a combination of quantitative parameters and qualitative assessment. Progressive tricuspid regurgitation (TR), the presence of a pericardial effusion, increased right atrial size and pressure, and decreased right ventricular function as illustrated by abnormal myocardial performance index (MPI), tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC) and RV strain are all features associated with poor prognosis in the context of pulmonary arterial hypertension (PAH). The frequency at which TTE should be repeated is determined by the underlying cause of PH. Patients with PH should be referred to a center with expertise in investigation and management of this condition.