Point of care venous Doppler ultrasound: Exploring the missing piece of bedside hemodynamic assessment

Figure 1 Normal time-correlated electrocardiographic findings, central venous pressure tracing, and hepatic venous waveform. The peak of the retrograde a wave corresponds with atrial contraction, which occurs at end diastole. The trough of the antegrade S wave correlates with peak negative pressure created by the downward motion of the atrioventricular septum during early to mid-systole. The peak of the upward-facing v wave correlates with opening of the tricuspid valve, which marks the transition from systole to diastole. The peak of this wave may cross above the baseline (retrograde flow) or may stay below the baseline (i.e., remain antegrade). The trough of the antegrade D wave correlates with rapid early diastolic right ventricular filling. ECG: Electrocardiographic; CVP: Central venous pressure; HV: Hepatic venous. Citation: McNaughton DA, Abu-Yousef MM. Doppler US of the liver made simple. Radiographics 2011; 31: 161-188. Copyright © The Authors 2020. Published by Radiological Society of North America (RSNA^®).

Figure 2 Transformation of the hepatic, portal, and intra-renal Doppler waveforms with increasing right atrial pressure. Asterisks on the portal waveform represent the highest and lowest points during a cardiac cycle used to calculate pulsatility fraction. RAP: Right atrial pressure.

Figure 3 Figure illustrating the integration of venous Doppler with other vital pieces of sonographic assessment including focused cardiac and lung ultrasound. Normal waveforms shown. IVC: Inferior vena cava. Human body image licensed from Shutterstock^®.

Figure 4 Example of ultrasound stigmata of severe venous congestion obtained from a patient with congestive heart failure exacerbation and tricuspid regurgitation. A: Dilated inferior vena cava; B: Hepatic vein Doppler demonstrating only D-wave below the baseline; C: Pulsatile portal vein with flow pauses in between the cardiac cycles; D: Ontra-renal vein demonstrating only D-wave below the baseline.