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Jugular Venous Pulse (JVP) (Ref. Hari. 18th ed., pg -1822)

Physiology :


Normal JVP height = less than 8 cm of blood


A, C, V = Positive wave


X, Y = Negative wave

  1. A wave (it corresponds to S4) atrial contraction. Q (Positive presystolic wave)
  2. C wave − bulging of tricuspid valve into right atrium during right ventricular isovolumetric systole Q
  3. V wave − increasing volume of blood in the right atrium during ventricular systole and isovolumetric
    1. Relaxation phase as the tricuspid valve is close Q
  4. X descent :  It is a negative systolic wave (Occurs due to 2 Reasons) −
    1. Atrial relaxation
    2. Downward displacement of tricuspid valve during ventricular systole Q
  5. Y descent: (It corresponds to S3)−opening of tricuspid valve and rapid inflow of blood into right ventricle Q

Abnormalities of JVP

  1. Raised JVP with normal waveform:
    1. Fluid overload
    2. Right heart failure Q
  2. Raised JVP with absent pulsation: SVC obstruction
  3. Large a wave:
    1. Tricuspid stenosis
    2. Pulmonary stenosis
    3. Pulmonary artery Hypertension.
  4. Cannon a wave:
    1. Complete heart block
    2. Junctional rhythm
    3. Atrioventricular dissociation.
  5. Absent a wave: atrial fibrillation Q
  6. Giant v wave: Tricuspid regurgitation. Q  (Carvallo’s sign)
  7. Slow y descent: Tricuspid stenosis Q
  8. Prominent y descent: Constrictive pericarditis, severe RHF, high venous pressure.
  9. Prominent x descent:  Constrictive pericarditis, Cardiac tamponade. Descent is reversed in TR. 

Important Points:


Abdominojugular reflux-

  1. Rise in JVP during 10 sec of mid abdominal compression followed by a rapid drop in pressure of 4 cm of blood in release of the compression. Q
  2. It indicates incipient right sided heart failure

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