Abnormalities of the JVP

1) Raised JVP with normal waveform

 right heart failure

 fluid overload
 bradycardia

2) Raised JVP with absent pulsation

 SVC obstruction - full dilated jugular veins, no pulsation, oedematous face and neck

3) Large a wave

 tricuspid stenosis - atria contracts against stiff tricuspid and so pressure in atria rises higher than normal
 pulmonary hypertension - there are generally higher pressures on the right side of the heart
 pulmonary stenosis

4) Extra-large a wave = Cannon wave

Occurs when atrium contracts against closed tricuspid eg

 complete heart block

 atrial flutter
 single chamber pacing
 nodal rhythm (AV node is in charge)
 ventricular extra-systole
 ventricular tachycardia

ie any condition in which the atria and the ventricles are not conducting in appropriate rhythm

5) Absent a wave

 atrial fibrillation

6) Systolic waves = combined c-v waves = big v waves

 tricuspid regurgitation (c-v wave because the pressure in the right atrium is raised throughout ventricular
systole - tip is to watch for earlobe movement!)

7) The slow y descent occurs in tricuspid stenosis (if the HR is so low as to allow the length of descent to be
appreciated!)

8) Paradoxical JVP = Kussmaul's sign

Normally the JVP should rise on expiration and fall on inspiration.

When the JVP rises on inspiration it indicates
 pericardial effusion
 constrictive pericarditis
 pericardial tamponade