Interesting #VExUS #POCUS case. Awaiting input from @ThinkingCC @ArgaizR & other sonophiles
Thread/
Middle aged pt with heart failure EF<30% with worsening renal function, low urine output. 1st Image - EPSS: increased as expected (likely some degree of error; anatomic M-mode NA)

VTI (my clips have not migrated yet...LV function depressed and appears dilated on apical 4C)

IVC. Difficult to obtain because of body habitus but confirmed entry into RA.

Portal vein #POCUS
Max 30% pulsatility

Hepatic vein. See S>D

Renal vein #POCUS. Difficult as usual due to inability to hold breath but seems continuous to me. RI is high, don't know why....may be a reflection of high SVR in heart failure?

My working diagnosis at this point was likely ATN...less likely congestive renal failure. Doesn't seem to be a grossly forward flow issue. Lowest systolic BP in 24 hrs - 110 mmHg

But the surprise was that CVP was 26 mmHg on right heart cath!! Something doesn't make sense...