Why are these veins so pulsatile?

First let's have a look at some examples of normal veins in 2 different patients. 

The above spectral Doppler ultrasound images are of 2 healthy patients with mild respiratory phasicity of normal popliteal and femoral veins. 

Next we see a patient with what I call moderately increased pulsatile veins. This is not normal. 

The above spectral Doppler ultrasound images show moderate increase in pulsatile waveforms in the veins. And they are bilateral. 

Why is this? This patient has bilateral pedal edema also. No evidence of deep vein thrombosis or DVT.

They are because of possible right heart failure. Right heart failure or congestive cardiac failure can cause increase in pulsatility of lower limb veins. 

Final diagnosis: increased pulsatility of veins due to possible CCF or congestive cardiac failure.

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Venous Doppler ultrasound