JUGULAR VENOUS PULSE wave formation and pathology

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00:00 Definition • 00:38 a wave • 01:02 c wave • 01:27 x descent • 02:14 v wave • 02:42 y descent • 03:23 a wave pathology • 06:36 Tricuspid regurgitation • 08:09 Constrictive pericarditis • 09:44 Cardiac tamponade • Jugular venous pulse is changing of jugular veins pressure during the cardiac cycle that reflects changing of Right atrial pressure due to straight connection between jugular veins and right atrium. Usually internal jugular vein is used for the most accurate measurement since it is in a direct line with the superior vena cava and right atrium. • The Abnormal a WaveThe augmented a wave can be tall and cannonThe amplitude of the a wave is heightened whenever the right atrium contracts against increased resistance. The tall a wave usually observed in case of RV hypertrophy, RV infarction or tricuspid stenosis.Cannon a wave describes exaggerated a wave that is usually observed in case of different rhythm and conductivity disorders. The a wave won’t be observed during periods of atrial asystole such as in case of atrial fibrillation, atrial flutter, or sinus arrest. • One of the most important changes of jugular venous pulse is caused by tricuspid regurgitation • The regurgitation jet from right ventricle to right atrium during the right ventricular systole causes right atrium volume overload that lead to impaired right atrium relaxation. As we already know that x descent is responsible for right atrium relaxation so in case of tricuspid regurgitation x descent will be attenuated or even absent.Also right atrium volume overload lead to augmentation of V wave because in this case right atrium obtain blood from vena cava system and additional blood from regurgitation jet that lead to increasing of V wave that is responsible for Right Atrium filling.Also flow thought the tricuspid valve increases because the pressure gradient between right atrium, and right ventricle increases. That lead to steep y descent that is responsible for right ventricle filling.In case of constrictive pericarditis due to constriction a relatively larger amount of atrial relaxation and filling occurs following ventricular contraction , since as blood is ejected to the great vessels during ventricular systole, ventricular volume transiently falls, enabling atrial expansion and filling. That lead to rapid drop of atrial pressure. Rapid fall of atrial pressure during ventricular ejection lead to steep x descent Also due to constriction ventricular filling is impaired and ventricular stroke volume is reduced. For a brief period linearly diastole, ventricular filling is rapid ; however, the limit of the ventricular distensibility is soon reached that lead to rapid and fast drop of Right atrium pressure during right ventricle filling that is reflected as steep y descent on jugular venous pulse contourThe cardiac tamponade is characterized by accumulation of fluid between pericardium layers. accumulation of fluid causes pressure on all heart chambers. As a result, right atrial relaxation and filling occur during rapid ventricular ejection because ventricular volume transiently falls, enabling atrial expansion and filling.This changes lead to rapid drop of right atrial pressure therefore steep x descentA unique feature of cardiac tamponade is the continuous compression of the heart throughout the cardiac cycle. This limits the fall in ventricular pressure during early diastole and thus causes a decrease in the normal atrium to ventricular pressure gradient in early diastole. This, in turn, restricts the amount of early diastolic filling of the ventricles and blunts the Y descent . • • Our telegram channel • https://t.me/foxterRier_med • AV block picturehttps://litfl.com/av-block-2nd-degree... of internal jugular vein picturehttps://geekymedics.com/jugular-venou... • Song: Deaf Kev - Invincible Pt. II (feat. Sendi Hoxha) [NCS10 Release] • Music provided by NoCopyrightSounds • Free Download/Stream: http://NCS.io/Invincible2 • Watch: • Deaf Kev - Invincible Part II (feat. ...

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