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Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome

Promptly recognizing congestion, both clinical and hemodynamic, is paramount in the management of patients with heart failure. The pathophysiology of congestion involves a complex interplay of absolute fluid gain, volume redistribution from venous capacitance beds to the central venous circulation,...

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Detalles Bibliográficos
Autores principales: Gudlawar, Sirisha, Koratala, Abhilash
Formato: Online Artículo Texto
Lenguaje:English
Publicado: S. Karger AG 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601848/
https://www.ncbi.nlm.nih.gov/pubmed/37900926
http://dx.doi.org/10.1159/000531709
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author Gudlawar, Sirisha
Koratala, Abhilash
author_facet Gudlawar, Sirisha
Koratala, Abhilash
author_sort Gudlawar, Sirisha
collection PubMed
description Promptly recognizing congestion, both clinical and hemodynamic, is paramount in the management of patients with heart failure. The pathophysiology of congestion involves a complex interplay of absolute fluid gain, volume redistribution from venous capacitance beds to the central venous circulation, inadequate excretion due to renal dysfunction, salt and water retention, and endothelial dysfunction. While congestive nephropathy is gaining wider recognition as a distinct variant of hemodynamic acute kidney injury (AKI), there are limited bedside diagnostic tools for proper evaluation of these patients. In this manuscript, we describe a case of AKI where POCUS helped us diagnose clinically silent congestion as well as monitor the response to therapy. A patient with heart failure with mildly reduced ejection fraction was initially administered intravenous fluids for rise in serum creatinine attributed to volume depletion. However, POCUS demonstrated a completely different scenario with severe venous congestion. Both sonographic stigmata of congestion and serum creatinine improved with diuretic therapy. Furthermore, serial venous excess Doppler ultrasound scans facilitated the visualization of decongestion in real time.
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spelling pubmed-106018482023-10-27 Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome Gudlawar, Sirisha Koratala, Abhilash Case Rep Nephrol Dial Case Report Promptly recognizing congestion, both clinical and hemodynamic, is paramount in the management of patients with heart failure. The pathophysiology of congestion involves a complex interplay of absolute fluid gain, volume redistribution from venous capacitance beds to the central venous circulation, inadequate excretion due to renal dysfunction, salt and water retention, and endothelial dysfunction. While congestive nephropathy is gaining wider recognition as a distinct variant of hemodynamic acute kidney injury (AKI), there are limited bedside diagnostic tools for proper evaluation of these patients. In this manuscript, we describe a case of AKI where POCUS helped us diagnose clinically silent congestion as well as monitor the response to therapy. A patient with heart failure with mildly reduced ejection fraction was initially administered intravenous fluids for rise in serum creatinine attributed to volume depletion. However, POCUS demonstrated a completely different scenario with severe venous congestion. Both sonographic stigmata of congestion and serum creatinine improved with diuretic therapy. Furthermore, serial venous excess Doppler ultrasound scans facilitated the visualization of decongestion in real time. S. Karger AG 2023-10-06 /pmc/articles/PMC10601848/ /pubmed/37900926 http://dx.doi.org/10.1159/000531709 Text en © 2023 The Author(s). Published by S. Karger AG, Basel https://creativecommons.org/licenses/by-nc/4.0/This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.
spellingShingle Case Report
Gudlawar, Sirisha
Koratala, Abhilash
Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome
title Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome
title_full Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome
title_fullStr Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome
title_full_unstemmed Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome
title_short Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome
title_sort venous excess doppler ultrasound: a visual guide to decongestion in cardiorenal syndrome
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601848/
https://www.ncbi.nlm.nih.gov/pubmed/37900926
http://dx.doi.org/10.1159/000531709
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