Pulsatile Varicose Veins in Tricuspid Insufficiency

To the Editor.—  The diagnosis of tricuspid insufficiency, which is often functional in nature and secondary to primary left-sided heart disease or severe lung disease, is not infrequently difficult to diagnose clinically. The accentuated V-waves in the neck veins may be missed if there is severe right-sided failure and the upper limit of the venous column cannot be seen to pulsate. The classical sign of the pulsating liver may be misinterpreted as pulsation being transmitted from the abdominal aorta.Recently, three patients with known left- and right-sided failure were suspected of having functional tricuspid insufficiency. In addition to the classical findings of pulsatile jugular veins and a pulsatile liver, it was noted in these patients that the veins in the upper part of their thighs were also pulsating with ventricular systoles. The fact that the patients had prominent varicose veins probably facilitated the propagation of these pulsations. In one of