In our patient, the venous pulse is normal in mean pressure and wave form. Although the wave form seen here is different than that seen in some normals, it is common in young, healthy individuals with slow heart rates.

The small "a" wave due to right atrial contraction precedes a prominent systolic "x" descent due to atrial relaxation. Next, the small "v" wave reflects passive filling of the right atrium, and the "y" descent reflects emptying of the right atrium after the tricuspid valve opens. The "h" wave follows, due to continued gradual filling of the right heart in mid to late diastole. The individual "h" and "a" waves are subtle, and the following "x" descent stands out as the dominant event in this variant of normal. In the video, note the prominent "x" descent occurs with the carotid impulse. The cotton swab reflects the carotid impulse.