JVP

Normal Jugular venous pulsations: PA cath waveform

• • a wave: reflect the rise in atrial pressure that accompanies atrial contraction. Occurs before the S1 and before the carotid pulse.

  • c wave: Bulging of the tricuspid valve back into the right atrium at start of right ventricular systole, when the valve has closed.

  • x descent: starts with atrial relaxation, as the ventricle is contracting and pulls down the closed TV ring.

  • v wave: Blood entering passively into the right atrium, during ventricular systole while the TV is closed.

  • y descent: opening of the tricuspid valve in diastole with rapid emptying of the right atrium.

Abnormal patterns of JVP:

• • Cannon a waves: AV dissociation (the atrium contracts against a closed TV). Junctional rhythm.

  • Large a waves: Tricuspid stenosis, pulmonary HTN, pulmonary stenosis.

  • Absent a waves: Atrial fibrillation (AF).

  • Large cv wave: Tricuspid regurgitation.

  • Rapid y descent: Constrictive pericarditis, restrictive cardiomyopathy.

  • Blunted y descent: Cardiac tamponade.