Echocardiography provides valuable information to diagnose heart dysfunction. A typical exam records several minutes of real-time cardiac images. To enable complete analysis of 3D cardiac strains, 4-D (3-D+t) echocardiography is used. This results in a huge dataset and requires effective automated analysis. Ultrasound speckle tracking is an effective method for tissue motion analysis. It involves correlation of a 3D kernel (block) around a voxel with kernels in later frames. The search region is usually confined to a local neighborhood, due to biomechanical and computational constraints. For high strains and moderate frame-rates, however, this search region will remain large, leading to a considerable computational burden. Moreover, speckle decorrelation (due to high strains) leads to errors in tracking. To solve this, spatial motion coherency between adjacent voxels should be imposed, e.g., by averaging their correlation functions.1 This requires storing correlation functions for neighboring voxels, thus increasing memory demands. In this work, we propose an efficient search using PatchMatch, 2 a powerful method to find correspondences between images. Here we adopt PatchMatch for 3D volumes and radio-frequency signals. As opposed to an exact search, PatchMatch performs random sampling of the search region and propagates successive matches among neighboring voxels. We show that: 1) Inherently smooth offset propagation in PatchMatch contributes to spatial motion coherence without any additional processing or memory demand. 2) For typical scenarios, PatchMatch is at least 20 times faster than the exact search, while maintaining comparable tracking accuracy.