The c wave:
Occurs simultaneously with the carotid pulse
Artifact by Carotid pulsation
Bulging of TV into RA during ICP
v WAVE
Rising right atrial pressure when blood flows into the right
atrium during ventricular systole when the tricuspid valve is
shut.
Synchronous with Carotid pulse
Begins in early systole, Peaks after S2 and ends in early
diastole
y DESCENT
The a wave occurs just before the first sound or carotid pulse
and has a sharp rise and fall.
The v wave occurs just after the arterial pulse and has a slower
undulating pattern.
1. Hypovolaemia.
B. Elevated jugular venous pressure
1. Intravascular volume overload conditions
Right ventricular infarction
Left heart failure
Myocardial infarction.
Valvular Heart Disease
Cardiomyopathy
2. Constrictive pericarditis.
3. Pericardial effusion with tamponade
Elevated a wave
Increased Resistance to
RV Filling.
Tricuspid stenosis
R Heart Failure
PS
PAH
Cannon a wave
Atrial-
ventricular
Dissociation
(atria contract against
a closed tricuspid
valve)
Complete heart block
VPC
Ventricular
tachycardia
Ventricular pacing
Junctional rhythm
Junctional
tachycardia.
Absent a wave
1. Atrial fibrillation
Elevated v wave
1. Tricuspid regurgitation.
2. Right ventricular failure.
3. Restrictive cardiomyopathy.
4. Cor Pulmonale
Tricuspid regurgitation
Absent X Decsent
CV/ Regurgitant Wave
Has a rounded contour
and a sustained peak
Followed by a rapid deep
Y descent
Amplitude of V increases
with inspiration.
Cause subtle motion of
ear lobe with each heart
beat
a wave equal to v wave
ASD
Prominent X descent
followed by a large V
wave
M Configuration
Indicates a large L-R
shunt
With PAH A wave
becomes more
prominent
If L JVP > R JVP
indicates associated
PAPVC
Prominent x descent
1. Cardiac tamponade.
2. Constrictive Pericarditis
3. RVMI
4. Restrictive Cardiomyopathy
5. Atrial septal defect
Blunted x descent
1. Tricuspid regurgitation.
2. Right atrial ischaemia
Prominent y descent
1. Constrictive pericarditis.
2. Tricuspid regurgitation.
3. Atrial septal defect.
Absent y descent
1. Cardiac tamponade.
2. Right ventricular infarction
3. Restrictive Cardiomyopathy
Slow y descent
1. Tricuspid stenosis.
2. Right atrial myxoma.
Constrictive pericarditis.
M shaped contour
Prominent X and Y descent (FRIEDREICH`SIGN)
Y descent is prominent as ventricular filling is
unimpeded during early diastole.
This is interrupted by a rapid raise in pressure as the
filling is impeded by constricting Pericardium
The Ventriclar pressure curve exhibit Square Root sign
Abdomino-jugular reflux
Is positive when JVP increase after 10 sec of abdominal
pressure followed by a rapid drop in pressure of 4 cm on release
of compression.
Constrictive Pericarditis
Severe RHF
Restrictive Cardiomyopathy
Tricuspid Stenosis