Examination of arterial pressure pulse with Jugular Venous Pulse (JVP)


ExaminationHow to take good medical history & examination. Read more ... » of arterial pressure pulse

Examination of arterial pressure pulse 1

Examination of arterial pressure pulse

  • The arterial pulse has an anacrotic shoulder on the ascending limb and then a rounded peak, then a down­ward deflection called incisura and then the pulse wave gradually comes down.
  • In peripheral pulses the anacrotic shoulder is not seen and incisura is replaced by dicrotic notch which is smooth.
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The different types of pulses are:

Pulsus parvus –

small, weak pulse due to de­creased strokeHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... » volume and narrow pulse pres­sure.

Pulsus tardus

in aortic stenosisAortic Stenosis Symptoms Aortic Stenosis Physical Findings Auscultation TREATMENT. Read more ... » is a slow pulse with a delayed peak.

Hyperkinetic pulse –

  • due to increased LV stroke volume, wide pulse pressure as in CHB, or hy­perkinetic circulation like anaemia, exercise, fe­ver, POA, AR, MR, and VSO.

Bisferiens pulse

Pulsus alternans

  • is a pulse with alternate tall and short peaks due to left ventricular failure.

Pulsus bigeminus

  • is due to premature ventricu­lar contraction after every beat, giving rise to a pulse coming in pairs.

Pulsus paradoxus –

  • there is an exaggerated fall in systolic arterial pressure during inspiration. The fall is more than 10 mmHg so that the pe­ripheral pulse may be seen to disappear during inspiration.


Radiofemoral delay

Jugular Venous Pulse (JVP) 1

Examination of Jugular Venous Pulse (JVP)


Examination of Jugular Venous Pulse (JVP)

  • The JVP is best seen in right internal jugular vein with the trunk inclined at 30 to 45°. With high JVP the  trunk is elevated to 90° to see the upper level of venous pulse.
  • The head is flexed a little to relax the neck veins and a tangential light from a torch is thrown across the skin over the vein to see the internal jugular vein.
  • The JVP has 3 positive waves and 2 negative troughs.
  • The positive waves are a, c, v and the negative waves are x and y.
  • The ‘a’ wave is produced by right atrial contraction.
  • The ‘c’ wave is produced by bulging of tricuspid valve into the right atrium during right ventricular systole and also due to the pulsation of carotid artery adja­cent to jugular vein.
  • The ‘x’ descent is due to atrial relaxation.
  • The positive ‘v’ wave is due to filling of the right atrium when  the tricuspid valve is closed.
  • The ‘y’ descent is due to opening of tricuspid valve and emptying of the right atrium.


Causes of large ‘a’ wave


CausesMetabolic,Insulin Resistance Syndrome X Causes Symptoms. Read more ... » of absent ‘a’ wave


Causes of prominent xdescent


Causes of loss of x’ descent


Causes of cv’ waves

  • Triscuspid regurgitation (due to no ‘x’ descent)


Causes of deep ‘Y‘ descent


Causes of slow ‘Ydescent

  • TS (tricuspid stenosis)
  • Right atrial myxoma


Normal JVP (Jugular Venous Pressure)

  • Normal JVP is measured from the sternal angle.
  • The vertical distance between the top of the venous column and the level of sternal angle is usually less than 3 cm. This distance is 3 cm + 5 cm = 8 cm from the centre of right atrium.
  • High venous pressure is seen in increased RV dias­tolic pressure.


Abdominojugular reflux test


Kussmaul’s sign

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