Our patient’s jugular venous pulse is normal, that is, the “a” wave that precedes the carotid impulse is greater than the “v” wave that occurs just after the carotid impulse.

Again, in a patient with a differential diagnosis of chest pain, it is important to assess the jugular venous pulse. For example, a patient with a large pulmonary embolism might develop acute pulmonary hypertension, resulting in an elevation of their central venous pressure and a giant “a” wave in the neck.

Now let’s everyone look at our patient’s jugular venous pulse together. I’m going to use the cotton swab, so that systole may be timed, and we can all see that the “a” wave is occurring just before the carotid and is dominant. But note especially that what strikes you is the collapse of the “a” wave, that is, the “x” descent, and this is a variation of normal.