Daniels and TwiST electrocardiogram (ECG) scores have been proposed to detect right heart strain (RHS). Tricuspid Annular Plane Systolic Excursion (TAPSE) is a reliable indicator of RHS in patients with acute pulmonary embolism (PE). I aimed to investigate the relationship between these ECG scores, TAPSE, and the level of care required for patients with acute PE. This was a prospective observational study of 110 patients undergoing CTA for suspected PE. ECGs were obtained and patients underwent bedside echocardiography. Low TAPSE was defined as ≤17 mm. Mean Daniels and TwiST scores were compared to mean TAPSE, and all were used to evaluate the risk of requiring "PE elevated care" (PEEC), defined as care more aggressive than simple heparination. Mean Daniels and TwiST scores were significantly different between low and high TAPSE groups (p<0.0001), and high Daniels and TwiST scores correlated to low TAPSE (p<0.0001, p=0.0002). PE positive (PE+) patients had lower mean TAPSE than PE negative (PE-) patients (p=0.0003). PE+ patients had a higher mean Daniels score and mean TwiST score than PE- patients (p=0.0024, p=0.0033). Patients requiring PEEC had lower mean TAPSE (p=0.047) and higher mean TwiST (p=0.020) values. TAPSE ≥17 mm and TwiST ≥5 had increased risks of 6.9 (p=0.045) and 4.4 (p=0.025) respectively for requiring PEEC. Both the Daniels and TwiST ECG scores correlated with TAPSE. All three were predictive of PE on CTA, while TAPSE and TwiST were predictive of requiring PEEC, suggesting their prognostic value in PE care.