In the JVP, ‘a’ waves are absent in –
Correct Answer: Atrial fibrillation
Description: The a wave reflects right atrial presystolic contraction and occurs just after the electrocardiographic P wave, preceding the first hea sound (S1).A prominent a wave is seen in patients with reduced right ventricular compliance; a cannon a wave occurs with atrioventricular (AV) dissociation and right atrial contraction against a closed tricuspid valve. In a patient with a wide complex tachycardia, the appreciation of cannon a waves in the jugular venous waveform identifies the rhythm as ventricular in origin. The a wave is not present with atrial fibrillation. Ref Harrisons internal medicine 20e p1668
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