During breathing, in the normal subject, lower limb venous Doppler tracings may consist not only of waves correlated to respiratory activity but also related to cardiac activity. The venous flow velocity increases or decreases in relation to both the respiratory cycle phases and the heart cycle phases.
In right ventricular dysfunction venous pressure increases, so the respiratory dependence of the venous flow may be removed. In this case the spectrum of the femoral veins changes: a pulsatile flow appears (cardiac modulated flow, with a cyclic retrograde component).
This pulsatile venous flow is, however, not only present in right ventricular dysfunction but also noted in normal subjects without history of heart disease. In these subjects, perhaps in a low compliance system, the pulsatility flow is a reflection of the haemodynamic state of the lower extremity venous system.
The pulsatile venous flow in the lower limbs veins may be an indicator of right heart failure: in these cases, therefore, the clinician should consider a complete cardiological evaluation.
Franco Accorsi, MD
Member of the Order of Physician of Bologna n° 6728
I am a specialist in Medical Angiology and I am based in Bologna, Italy. Until 2008 (voluntary resignation) I worked at Maggiore Hospital in Bologna as "Dirigente Medico" in the Department of Internal Medicine and as Angiologist in the Angiology Unit with a position of "Alta Professionalità" in "Vascular Ecography and Angiology".
I am currently working in Bologna as an independent professional in the areas of angiology and vascular diagnostics.
I have been a speaker at national and international courses/congress and I have taught duplex ultrasound method in GIUV and SIUMB courses at the Maggiore Hospital, Bologna and courses of echocolor Doppler of extracranial and intracranial arteries at the Stroke Unit of S. Maria Nuova Hospital, Reggio Emilia.