Rapid X descent is unlikely in-
Correct Answer: RVM
Description: The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system visualization of the internal jugular vein. It can be useful in the differentiation of different forms of hea and lung disease. Classically three upward deflections and two downward deflections have been described. The upward deflections are the "a" (atrial contraction), "c" (ventricular contraction and resulting bulging of tricuspid into the right atrium during isovolumetric systole) and "v" = venous filling The downward deflections of the wave are the "x" (the atrium relaxes and the tricuspid valve moves downward) and the "y" descent (filling of ventricle after tricuspid opening Differentiation from the carotid pulse : The JVP and carotid pulse can be differentiated several ways: multiphasic - the JVP "beats" twice (in quick succession) in the cardiac cycle. In other words, there are two waves in the JVP for each contraction-relaxation cycle by the hea. The first beat represents that atrial contraction (termed a) and second beat represents venous filling of the right atrium against a closed tricuspid valve (termed v) and not the commonly mistaken 'ventricular contraction'. These wave forms may be altered by ceain medical conditions; therefore, this is not always an accurate way to differentiate the JVP from the carotid pulse. The carotid aery only has one beat in the cardiac cycle. non-palpable - the JVP cannot be palpated. If one feels a pulse in the neck, it is generally the common carotid aery. occludable - the JVP can be stopped by occluding the internal jugular vein by lightly pressing against the neck. It will fill from above. The jugular venous pulsation has a biphasic waveform. The a wave corresponds to right atrial contraction and ends synchronously with the carotid aery pulse. The peak of the 'a' wave demarcates the end of atrial systole. The x descent follows the 'a' wave and corresponds to atrial relaxation and rapid atrial filling due to low pressure. The c wave corresponds to right ventricular contraction causing the tricuspid valve to bulge towards the right atrium during RV isovolumetric contraction. The x' descent follows the 'c' wave and occurs as a result of the right ventricle pulling the tricuspid valve downward during ventricular systole (ventricular ejection/atrial relaxation). (As stroke volume is ejected, the ventricle takes up less space in the pericardium, allowing relaxed atrium to enlarge). The x' (x prime) descent can be used as a measure of right ventricle contractility. The v wave corresponds to venous filling when the tricuspid valve is closed and venous pressure increases from venous return - this occurs during and following the carotid pulse. The y descent corresponds to the rapid emptying of the atrium into the ventricle following the opening of the tricuspid valve. Ref Davidson 23rd edition pg 456
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