Jugular Venous Pulse, Pressure and abnormalities

Jugular Venous Pressure is pressure of right atrium. If pressure of right atrial is high then JVP also increase if right atrial pressure is low JVP also low.

- Therefore JVP is determined by right atrial pressure.

Details illustrations about JVP ( Jugular Venous Pulse )

                                                             Click image to enlarge view
a wave = Right atrial contraction ( Atrial systole )
c wave = Transmitted carotid impulse at onset of systole ( Due to bulging of the tricuspid valve ring into the atria during ventricular contraction )
x descent = Right atrial relaxation at ventricular systole ( Onset of atrial relaxation )
v wave= Passive atrial filling during closed tricuspid valve and Venous return
y descent = Passive right ventricular filling at start of ventricular diastole or tricuspid valve opening.



Abnormal JVP waves:

1, Raised JVP with normal waveforms

• Right heart failure
• Volume overload
• Bradycardia

2, Large a wave

• Tricuspid valve stenosis
• Pulmonary hypertension
• Pulmonary valve stenosis

3, Cannon A wave 

It is powerful atrial wave due to contraction of the right atrium against closed tricuspid valve.

• Supraventricular Tachycardia
• Complete heart block without Atrial fibrillation
• AV dissociations ( Atria and ventricles are not conducting appropriate rhythm )
• Ventricular extra systole
• Nodal rhythm
• Pulmonary hypertension
• Tricuspid stenosis

4, Raised JVP with no pulsation

• Superior venacava obstruction

5, Absent a wave

• Atrial fibrillation

6, Kussmaul's sign ( Paradoxical JVP ): Physiologically JVP is rise during expiration and fall during inspiration. But in case of Kussmaul's sign JVP is increases during inspiration. Some conditions are:

• Constrictive pericarditis***
• Pericardial tamponade***
• Pericardial effusion***
• Restrictive cardiomyopathy**
• Tricuspid stenosis
• Right heart failure ( Cor pulmonale )
• Right ventricular infarction

*** = Most common causes

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