Pulses and JVP

Central venous pulse gives more information than peripheral radial pulse regarding LV function or aortic valve function.

1) Pulsus parvus - Common in diminished LV stroke volume

2) Hypokinetic pulse- Hypovolemia, LV failure, Restrictive pericardial disease, MV stenosis

3) Hyperkinetic pulse- Increased LV stroke volume, Wide pulse pressure, CHB, Anxiety, anemia, Beri-Beri, fever, AV fistula

4) Bisferiens pulse- Aortic regurgitation , HOCM

5) Pulses alternans- Severely diminished LV contractile force

6) Pulses paradoxus- Pericardial tamponade, airway obstruction, SVC obstruction



Jugular Venous Pulse ( JVP) :

JVP reflects phasic pressure changes in right atrium

Normal JVP consists of three positive waves and two negative troughs.

" a " Wave : Due to venous distension due to right atrial contraction

" c " Wave : Positive wave produced by bulging of tricuspid valve into right atrium during right ventricular systole

" v " Wave : Due to increased volume of blood in right atrium during ventricular sysole when tricuspid valve is closed..

Abnormalities:

Large "a" Wave : Tricuspid stenosis

Pulmonar stenosis

Pulmonary hypertension

Cannon " a" wave :

Regularly : Junctional rhythm

Irregularly : AV dissociation or Complete heart block

Absent " a" wave : Atrial fibrillation

" x" descent : Seen in constrictive pericarditis

Prominent " v " wave : Tricuspid regurgitation

" y " descent : Opening of tricuspid valve and rapid flow of blood into right ventricle

Rapid "y" descent : Severe TR

Slow " y" desent : Suggest obstruction to right ventricular filling e. g. tricuspid stenosis and Right atrial myxoma

Kussmaul sign : Increase in CVP during inspiration rather than normal decrease .Seen in

Severe right sided heart failure as in cases of right ventricular infarction and

Constrictive pericarditis

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