Jugular Venous Pulse (JVP): Examination, Waves, and Clinical Significance

Jugular Venous Pulse (JVP): Examination, Waves, and Clinical Significance

Question. Write a short answer on the jugular venous pulse.

Answer. Jugular venous pulse is an important physical sign of cardiovascular disease.
This pulse is examined for pressure and waveforms.

Procedure for measuring jugular venous pulse

This is examined y reclining the patient against pillows at 450 angle, neck muscles should be relaxed, upper level of pulsation of an internal jugular vein is seen, though the vein may itself not be visible.

In a normal person, jugular venous pulsation in above said position remains either behind the clavicle or below it and rarely extends beyond 2 to 3 cm above the sternal angle.

Waveforms of jugular venous pulse

Waveform of jugular venous pulse in patient of sinus rhythm is:

1. ‘a’ wave occur due to atrial systole. This is absent in atrial firillation but becomes large in tricuspid stenosis, right ventricle hypertrophy and pulmonary hypertension.
2. ‘c’ wave corresponds to tricuspid closure ‘v’ wave result from building of pressure in right atrium during ventricular systole when tricuspid valve is closed.

1. This wave becomes prominent in tricuspid regurgitation or congestive heart failure.
2. All the above mention three waves i.e. a, c and v waves are known as positive waves.
3. There are two more waves present beside these which are known as negative waves or descents i.e. x and y descents.
4. ‘x’ descent correspond with atrial relaxation and downward displacement of tricuspid valve at the time of ventricular systole. It is prominent in constrictive pericarditis.
5. Following the summit of ‘v’ wave, negative ‘y’ descent is produced by opening of tricuspid valve and rapid flw of blood in right ventricle.
6. Prominent ‘y’ descent occurs in constructive pericarditis and congestive heart failure along with ‘v’ wave, so it is collectively known as prominent ‘v’ wave and ‘y’ descent.
7. Slow ‘y’ descent occurs in tricuspid stenosis where ‘a’ wave is prominent.
8. Giant ‘a’ wave is a large sharp systolic wave seen in venous pulse during forcible contraction of right ventricle against closed tricuspid valve.
   It is seen in complete heart block, atrioventricular dissociation and junctional rhythm.