What does waves in JVP represent?
The upward deflections are :
- “a” (atrial contraction)
- “c” (ventricular contraction and resulting bulging of tricuspid into the right atrium during isovolumic systole)
- “v”= atrial venous filling.
The downward deflections of the wave are:
- “x”(the atrium relaxes and the tricuspid valve moves downward) and
- “y” descent (filling of ventricle after tricuspid opening).
ASK ME is the Mnemonic
Characteristics of the JVP
- Multiphasic – the JVP “beats” twice (in quick succession) in the cardiac cycle. In other words, there are two waves in the JVP for each contraction-relaxation cycle by the heart.The first beat represents that atrial contraction (termed a) and second beat represents venous filling of the right atrium against a closed tricuspid valve (termed v) and not the commonly mistaken ‘ventricular contraction’.
- Non Palpable
- Occludable
- Varies with respiration – the JVP usually decreases with deep inspiration. Physiologically, this is a consequence of the Frank–Starling mechanism as inspiration decreases the thoracic pressure and increases blood movement into the heart (venous return), which a healthy heart moves into the pulmonary circulation.
What is Paradoxical JVP?
Also known as Kussmauls sign
JVP rises on inspiration drops with expiration seen in:
- Constrictive pericarditis
- Pericardial effn
- Cardiac tamponade
- Raised JVP, normal waveform
- Bradycardia
- Fluid overload
- Heart Failure
- Raised JVP, absent pulsation
- Superior vena cava syndrome
- Large ‘a’ wave (increased atrial contraction pressure)
- tricuspid stenosis
- Right heart failure
- Pulmonary hypertension
- Cannon ‘a’ wave (atria contracting against closed tricuspid valve)
- Atrial flutter
- Premature atrial rhythm (or tachycardia)
- third degree heart block
- Ventricular ectopics
- Ventricular tachycardia
Absent ‘a’ wave (no unifocal atrial depolarisation)
- atrial fibrillation
- Large ‘v’ wave (c-v wave)
- Tricuspid regurgitation
- Slow ‘y’ descent
- Tricuspid stenosis
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