What have we learned together from evaluating our patient's jugular venous pulse wave form? Was it normal or did it provide a clue to a diagnosis? Well, we saw two impulses just as you would in the normal situation. We saw an "a" wave occurring prior to systole and a "v" wave just after systole, but focus on the height of those waves relative to each other. Let's look together using a cotton swab again as the timing device on the carotid. Everybody observe the impulse in the neck. (Cut-away)
In our patient, the second wave, that is, the "v" wave, is a bit enhanced, in fact, it is equivalent to the "a" wave. Is that a variation of normal or is it a clue to a diagnosis? For example, if it were a clue to a diagnosis, could this patient have a modest degree of tricuspid regurgitation? Could they possibly have an atrial septal defect? Let us proceed with the evaluation.
Normal vs. our patient graphic
By comparing the graphic of a normal patient to our patient, we can appreciate that our patient's "v" wave is larger. Equally prominent "a" and "v" waves usually occur as a result of an enhanced "v" wave, reflecting increased right atrial filling. This is typically seen in mild-to-moderate tricuspid regurgitation and atrial septal defects.