Thread by @NephroP

OK #VExUS #POCUS hemodynamicians, welcome back to the case. As promised, here are some follow up images:
@ArgaizR @ThinkingCC @khaycock2 @katiewiskar @Thind888 @MDBeni et al.
Hepatic v. 👇

Looks D-only but could this be S-wave? (or a delayed D? Pt has Afib and predisposed to having smaller S but wondering if there is some S-D fusion here)

Forgot, here is the IVC. Similar to previous.

Portal vein #POCUS #VExUS
Interesting! Isn't it? (previously 100% pulsatile with flow interruptions)

Now the real twist:
* Patient did not get extra-UF for various reasons. I thought of repeating #POCUS anyways prior to discharge
* Why there seems to be improvement? Was the first scan 'too soon' after HD to appreciate flow changes? I thought flow changes should be quick 🤔

Don't know exact weight at the time of scan but at least 1 kg higher than of end-HD based on last available measurement (different scale).
Here is the PSAX you guys were asking for 👇 Obtained in left lateral position.

M-mode. Kind of oblique but greyscale #POCUS seems to show septal flattening throughout the cycle. What u think @khaycock2 ?

Subcostal SAX. No septal flattening? (different myocardial segments but does that alter D-sign?) #POCUS

Apical 4C. Likely more tilted angle of insonation making RV look bigger.

TR

TR jet and RVOT Doppler
Does this RVOT Doppler tell anything qualitatively? 🤔#POCUS

Septal TDI and Mitral inflow

@MDBeni, with respect to your question about management, cardiology will evaluate for TAVR as outpatient. They initiated work up including chest CT, which incidentally showed findings suggestive of chronic PE 🤔