Master Of Medicine

What does waves in JVP represent?

The upward deflections are :

1. “a” (atrial contraction)
2. “c” (ventricular contraction and resulting bulging of tricuspid into the right atrium during isovolumic systole)
3. “v”= atrial venous filling.

The downward deflections of the wave are:

1. “x”(the atrium relaxes and the tricuspid valve moves downward) and
2. “y” descent (filling of ventricle after tricuspid opening).

ASK ME is the Mnemonic

Characteristics of  the JVP

1. 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’.
2. Non Palpable
3. Occludable
4. 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:

1. Constrictive pericarditis
2. Pericardial effn
3. Cardiac tamponade

• Raised JVP, normal waveform
  1. Bradycardia
  2. Fluid overload
  3. Heart Failure
• Raised JVP, absent pulsation
  1. Superior vena cava syndrome
• Large ‘a’ wave (increased atrial contraction pressure)
  1. tricuspid stenosis
  2. Right heart failure
  3. Pulmonary hypertension
  • Cannon ‘a’ wave (atria contracting against closed tricuspid valve)
  1. Atrial flutter
  2. Premature atrial rhythm (or tachycardia)
  3. third degree heart block
  4. Ventricular ectopics
  5. Ventricular tachycardia

  Absent ‘a’ wave (no unifocal atrial depolarisation)

  1. atrial fibrillation
• Large ‘v’ wave (c-v wave)
  1. Tricuspid regurgitation
• Slow ‘y’ descent
  1. Tricuspid stenosis