Expansion
a, c and v waves with x and y descents
Mnemonic
“a, c, v are the waves; x and y are the descents”:
- a - atrial contraction
- c - tricuspid bulging during ventricular contraction
- x - atrial relaxation
- v - venous filling of the atrium against a closed tricuspid valve
- y - tricuspid opening and rapid ventricular filling
Abnormalities each name a lesion:
- Absent a waves - atrial fibrillation
- Large a waves - tricuspid stenosis, pulmonary hypertension, pulmonary stenosis
- Cannon a waves - complete heart block, atrium contracting against a shut valve
- Giant v waves - tricuspid regurgitation
- Steep y descent - constrictive pericarditis (with Kussmaul’s sign)
- Absent y descent - cardiac tamponade
“Constriction has a sharp y, tamponade has none”, and Kussmaul’s sign, a JVP that rises on inspiration, occurs in constriction but classically not in tamponade.
Expansion
- a wave - atrial contraction
- c wave - bulging of the tricuspid valve into the atrium during isovolumetric contraction
- x descent - atrial relaxation and downward movement of the valve ring
- v wave - venous filling of the atrium against a closed tricuspid valve
- y descent - tricuspid valve opens and the atrium empties
Abnormal patterns follow directly:
- Absent a wave - atrial fibrillation
- Large a wave - resistance to atrial emptying: tricuspid stenosis, pulmonary hypertension
- Cannon a wave - atrium contracting against a closed tricuspid valve: complete heart block, ventricular tachycardia
- Giant v wave - tricuspid regurgitation
- Steep y descent - constrictive pericarditis
- Absent y descent - cardiac tamponade