A Guyton-based hypothesis for venous congestion

Despite much research and opinion, the underpinnings of venous congestion remain elusive. Many posit that elevated right atrial pressure (PRA) is the primum movens of venous congestion. However, a recent Geometrical model (GM) built from Guyton's framework advances that PRA is a dependent variable. The GM predicts that: 1.) venous Doppler patterns do not reflect volume state or responsiveness; 2.) venous congestion is not caused by PRA and, in fact, may occur with a low or normal PRA; and 3.) that venous Doppler patterns correspond to transmural rather than absolute PRA.