In congestive heart failure, what happens to the pulsatility of the subclavian vein?

• A. Increased pulsatility
• B. Decreased pulsatility
• C. No change in pulsatility
• D. Reversed flow pattern

Answer: (B)

Pulsatility of the subclavian vein is damped when central venous pressure is elevated, as happens in congestive heart failure. When the right atrial pressure is high, the downstream pressure in the central venous system reduces the transmural driving force that normally makes peripheral veins pulsate with the cardiac cycle. The result is a more continuous, less prominent pulsation in the subclavian vein on Doppler evaluation. In this scenario, the venous waveform appears blunted or decreased in pulsatility, reflecting the elevated central venous pressure associated with CHF.