Advanced Physical Diagnosis
  • Techniques
• Jugular Venous Pressure
• Jugular Waveforms
  • Demonstrations
Associated Evaluations
  • Patient HX
  • Physical Exam
  • Laboratory & Imaging
Differential Dx
Evidence Base
• Measurement of Jugular Venous Pressure
• Hepatojugular Reflux (HJR)
• Cardiac Hemodynamics
Teaching Tips
[Skill Modules >> Neck & Veins Examination >> Pathophysiology ]

Pathophysiology: Neck Veins

Jugular Venous Waves

What causes each of these pulsations?
In every cardiac chamber, pressure tracings are the exact opposite of volume tracings.
  • a wave is due to atrial contraction: It occurs just before the first heart sound and carotid pulse.
  • x descent is due to right atrial relaxation.
  • c wave is caused by the bulging of the tricuspid valve closing back toward the right atrium during ventricular isovolumetric contraction.
  • x descent is due to subsequent atrial relaxation.
  • v wave results when the filling in the atrium overcomes the descent of the base.
  • y descent is caused by the opening of the tricuspid valve. Thus the y descent cannot begin until after the S2.

X prime descent is most dominant wave and the most important as it correlates with systolic function.

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