Hepatic vein flow

HV S, D, reversal · Subcostal, PW 1–2 cm into a hepatic vein, with respiration trace

Normal range & thresholds

Normal: S > D forward flow, small reversals (a, v). Systolic flow reversal is specific for severe TR ^[4]. Expiratory diastolic reversal supports constriction; blunted flow with expiratory reversals supports tamponade/constriction physiology ^[24,57].

Pathophysiology

The hepatic veins are the RA’s window: systolic forward flow is generated by RA relaxation and annular descent; a regurgitant jet large enough to fill the RA reverses it. In constriction the fixed pericardial volume produces respirophasic reversals ^[57].

Raised by

—

Lowered by

• S blunting/reversal: severe TR, RV failure, AF (S blunted), restrictive filling

Technique & pitfalls

• Align with the vein; record respiration; average several beats.

Pseudo-change & artefact

• AF blunts S without TR; mechanical ventilation reverses respiratory patterns.

Treatment thresholds

• Supportive TR severity criterion; respiratory patterns support constriction vs restriction ^[4,57].

Next step

• TR grading (card 73); constriction work-up (Disorders).

Drugs

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Reversibility

Changes with TR and filling pressure.