inferior vena cava

Look at the diastolic indices, the left atrial size, the right ventricle, and the estimated pulmonary pressure.

The third secret is to look at the inferior vena cava.

A dilated IVC that doesn't collapse with inspiration suggests raised right atrial pressure.

The fourth is to always look for pericardial fluid in any hypotensive or breathless patient.

And the fifth, if the echo doesn't fit the clinical picture, repeat it or ask an experienced colleague to review it.

Patients with constriction are often referred to hepatologists because of ascites and a congested liver.

At the bedside, look for a pericardial knock, an early diastolic sound, and a rapid wide descent in the jugular venous pulse.

On echo, ask specifically for respiratory variation in mitral and tricuspid inflow, septal bounce, a dilated IVC, and the tissue Doppler pattern, which helps distinguish constriction from restriction.

The jet becomes laminar and low velocity, and the formula badly underestimates the pulmonary pressure.

Then the right atrial pressure estimate from the inferior vena cava is unreliable in patients on mechanical ventilation.

In athletes who often have a large IVC And in patients unable to sniff.

And finally, the right ventricle is a complex crescent-shaped chamber.

A single measurement like TAP see can be normal even when the global function is poor, especially after cardiac surgery, where TAP see falls in many patients even with preserved overall right ventricular function.

The second is image quality in ventilated supine patients.

Poor windows can lead to false conclusions.

The third is the IVC.

I, I appreciate clarification on that.

Um, now getting a little more technical, I was particularly, you know, I liked your schematics of the hemiazygos and azygos connections to the IVC and the ascending lumbar system, and it made me really appreciate how challenging it mu- this must be, particularly since the anatomy can be pretty variable.

And to what extent, when you're trying to catheterize this venous space, uh, do you have to rely on, um, sort of just exploration or, or imaging? Because what, what seems to me challenging about this is that your target is oftentimes determined on myelography, uh, whereas if you're gonna go for transvenous embolization, you may not necessarily have that live, uh, target available for you to see.

And, uh, just how do you reconcile that? And, um, how do you feel confident that where you do end up choosing to embolize, you know, you, you're truly at your target and, and you can avoid important things like radicular medullary veins and, and things like that?