Jugular Venous Pulse

Key points

• 'a' wave = atrial contraction — large with high atrial pressure (tricuspid stenosis, pulmonary stenosis, pulmonary hypertension); absent in atrial fibrillation
• Cannon 'a' waves = atrial contraction against a closed tricuspid valve: complete heart block · ventricular tachycardia/ectopics · nodal rhythm · single chamber ventricular pacing
• 'c' wave = closure of tricuspid valve (not normally visible) · 'v' wave = passive filling against a closed tricuspid valve — giant v waves in tricuspid regurgitation
• 'x' descent = fall in atrial pressure during ventricular systole · 'y' descent = opening of the tricuspid valve
• Non-pulsatile JVP = SVC obstruction · Kussmaul's sign = paradoxical JVP rise during inspiration (constrictive pericarditis)