What can we conclude from our evaluation of our patient’s jugular venous pulse wave form? We can conclude that it is normal. We can do that because we have a timing device, the carotid vessel. We’ll use the swab to reflect that, so that we can identify systole, we again observe the jugular venous pulse wave form, as you see undulations at the inferolateral aspect of the sternocleidomastoid, and there is an impulse just prior to systole, and a smaller one just after it. Those are the normal “a” and “v” waves, that is, it is a normal jugular venous pulse wave form.

Now, in some cases in this setting of acute infarction, the jugular venous pulse wave form may not be normal. An example might be that a patient with a right ventricular infarction could have some degree of tricuspid regurgitation. And then you’d see a pathologic “cv” wave welling up in the neck. Another example, and I am going to show you that, is the giant “a” wave. In some cases, again, in the context of a right ventricular infarct, there may be poor distensibility or compliance of the right ventricle, and then the atrium gives a greater kick, observed in the neck as a giant “a” wave. Let us look at that together. [Cut-away] there we see a giant “a” wave in the neck.