Ultrasound Guidance for Upper Extremity Arterial and Venous Access: Figure 3, Radial Tortuosity

An 82-year-old man presented with progressive dyspnea on exertion. He had chronic atrial fibrillation on anticoagulation with warfarin, moderate chronic obstructive pulmonary disease, and was found on echocardiography to have severe mitral regurgitation and moderate aortic insufficiency, moderate pulmonary hypertension, and severe left atrial enlargement. A brain natriuretic peptide was elevated at 332pg/mL. He achieved only 1.7 METs (metabolic equivalents of task) on a treadmill stress test before complaining of dyspnea. He was referred for left and right heart catheterization for evaluation of mitral regurgitation and pulmonary hypertension in preparation for mitral valve repair.  

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