Describe the spectral Doppler findings in a patient with severe tricuspid regurgitation.

Early peaking and midsystolic deceleration of the regurgitant jet are seen, owing to rapid equilibration of the left atrial and left ventricular pressures. In addition, one might see systolic reversal of the hepatic venous flow. (These findings correlate with a large v wave on a jugular venous pressure tracing.)