Examination of the jugular venous pulse often provides the first clue that the patient has significant right heart disease. An example of that may also be seen in a patient who has a large wave that occurs in systole, it is called the pathologic "cv" wave. Let's look at a patient with such a venous wave together, again, using the cotton swab as a timing device. [Cut-away]

That very large systolic wave in the venous pulse tells us something. It tells us that this patient has tricuspid regurgitation. When the ventricle contracts, blood wells up into the right atrium raising the pressure and that wave form is seen in the neck in systole. Another reflector of a patient with significant right heart disease.