heart ultrasound

A medical report might say that the patient has a “plethoric IVC.”

Here is a full description in plain English of what a plethoric IVC is and what causes it.

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“The heart is a pump,” begins George Ruiz, MD, chief of cardiology at MedStar Union Memorial and MedStar Good Samaritan Hospitals, who specializes in the care of adults with advanced heart failure, pulmonary hypertension, congenital heart disease and heart disease during pregnancy.

Dr. Ruiz continues, “As a pump it does two things – (1) fills and (2) pumps blood forward. Any problem with either of these vital functions may lead to heart failure.

“As a result of difficulties filling and pumping, the pressure in the heart increases, leading to a ‘backup’ of pressure throughout the system that drains into the heart.

“The IVC, also known as the inferior vena cava, is the drainage system for all blood returning to the heart below the diaphragm.

“If the heart fails, the pressure/blood backs up, leading to enlarged/engorged veins – the IVC is one of them.”

heart diagram

What exactly is heart failure?
Heart failure is NOT a heart attack and it’s not when the heart stops beating.

It’s when the heart either fails to fill with an adequate amount of blood to be pumped out (diastolic heart failure), or, the heart actually fills with an adequate amount – but the pumping action is poor (systolic HF).

The enlarged or engorged veins (too much fluid in these vessels) may be visible through the abdominal skin.

The engorgement may also affect veins near the anus, twisting and swelling them, leading to hemorrhoidal bleeding with bowel movements.

Another name for plethoric IVC is congested IVC. There may or may not be fluid buildup in the legs with this situation.

“Basically, it means that the patient has evidence that they are holding onto extra fluid,” says Dr. Ruiz.

“This is found on an echocardiogram study – an ultrasound study of the heart and vessels.”

A physician is able to look at the ultrasound image and identify the abnormality as a plethoric inferior vena cava.

This is a life-threatening condition, particularly in people over age 80, a sign of very poor cardiac function.

In the very elderly with longstanding systolic heart failure, a plethoric IVC signals a very dismal prognosis.