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 >> Techniques ]

Techniques: Jugular Venous Wave Form Analysis

Identifying jugular venous wave forms gives you a clue as to heart function and also allows for diagnosing arrhythmias at the bedside.

There are two important waves: a wave & v wave

normal wave
Normal neck veins show a big a wave, with a v wave

Neck vein wave forms have a gradual upslope and a dramatic collapse. This is the exact opposite of the carotid, which have a dramatic upslope and a gentle collapse.

Because the collapse in neck veins is the most dramatic movement , it is what you time when you are trying to determine what type of wave it is:

Big x prime descent a wave
Big y descent v wave

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How do you time which is x descent and which is y descent?

The easiest way is to time it with S2.

  • The x prime descent seems to collapse into S2, so it is lub clap dub (where clap is the wave collapse).
  • The y descent seems to begin only after S2. So it is lub dub clap lub dub clap (where clap is the wave collapse).
When you listen to the left base of the heart, the S2 is always the loudest sound. What you'll notice is that this collapses right into S2.

Many cardiologists just time it with the carotid.

  • The x prime descent is coincident with the tap of the fingers, whereas the y descent seems to alternate with the tap of the fingers.
Rest your hand on the opposite carotid. Say C- to yourself every time there is a tap on the finger . C-C- C- Then say C-down C-down with the down as fast as you can after the C. The down will correlate with the X prime descent. This is a regular pulse with a dominant a wave.

Historical Note: The waves were named by James McKenzie. He thought that the C wave was from the carotid, so named it "C".

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