the recording of jugular venous & carotid arterial pulses

The Recording of Jugular The Recording of Jugular Venous & Carotid Arterial Venous & Carotid Arterial

PulsesPulses

Dr. AbeerDr. Abeer Cardiovascular PracticalCardiovascular Practical 22

Objectives:Objectives:

To be able toTo be able to:: identify,identify, understand the events causing the understand the events causing the

different waves of the JVP & CP tracings.different waves of the JVP & CP tracings.


A. The Carotid Arterial PulseA. The Carotid Arterial Pulse

MethodMethod::

1.1. Subject lies quietly on a couch.Subject lies quietly on a couch.2.2. Feel CAP on medial side of Feel CAP on medial side of

sternomastoid muscle.sternomastoid muscle.3.3. Apply transducer over CA using Apply transducer over CA using

soft rubber band & connect it to soft rubber band & connect it to recorder.recorder.


• Pulse:

Record of pressure changes created

by ejection of blood from LV into

already full aorta & is propagated as a

wave over the vessel wall.


Recorded CAP graph:Recorded CAP graph:

Anacrotic limbAnacrotic limb:: - - Record during maximum ejection phase Record during maximum ejection phase of ventricular systole.of ventricular systole. Dicrotic notch (Incisura)Dicrotic notch (Incisura):: - - Due to closure of aortic valve.Due to closure of aortic valve. Dicrotic waveDicrotic wave:: - - Due to elastic recoil of arterial wall.Due to elastic recoil of arterial wall. Dicrotic limbDicrotic limb:: (descending)(descending)


Cardiac Cycle duration = 0.8 sec.Cardiac Cycle duration = 0.8 sec. Ventricular systole = 0.3 sec.Ventricular systole = 0.3 sec. Ventricular diastole = 0.5 sec.Ventricular diastole = 0.5 sec.


Aortic StenosisAortic Stenosis:: - - Slow rising pulse, small volume, late systolic peak.Slow rising pulse, small volume, late systolic peak. Shock or dehydrationShock or dehydration:: - - weak or thready pulse, due to weak or thready pulse, due to volume. volume. Aortic RegurgitationAortic Regurgitation:: - - Collapsing pulse (water hummer). Collapsing = Collapsing pulse (water hummer). Collapsing = Diastolic leak back to Lt. ventricle. Rapid up stroke (Diastolic leak back to Lt. ventricle. Rapid up stroke ( stroke volume & stroke volume & pulse wave). pulse wave). HypertensionHypertension:: - - Bounding pulse, due to good volume.Bounding pulse, due to good volume. PregnancyPregnancy:: (N)(N) - due to good volume.- due to good volume.

Clinical abnormalities:Clinical abnormalities:


B. The Jugular Venous PulseB. The Jugular Venous Pulse

MethodMethod::1.1. Subject performs Valsalva manoeuvre (deep Subject performs Valsalva manoeuvre (deep

inspiration followed by forced expiration inspiration followed by forced expiration against closed glottis), internal jugular vein will against closed glottis), internal jugular vein will be prominent.be prominent.

2.2. Choose position on the IJV away from CA.Choose position on the IJV away from CA.

3.3. Place pulse transducer over the vein & keep it Place pulse transducer over the vein & keep it in position with self adhesive plaster.in position with self adhesive plaster.

4.4. Connect to recorder.Connect to recorder.


Pressure changes in RA can be recorded from IJV as there are no valves between them.The EJV can’t be relied because it:1. has valves, 2. ? obstructed by facial & muscular layers through which it passes.

JVP in:1. Rt. Sided heart failure.2. Fluid overload.


Recorded JVP graph:Recorded JVP graph:

Upward deflectionUpward deflection::

a, c, & v waves.a, c, & v waves.

Downward deflectionDownward deflection::

x & y descents.x & y descents.


Causes of these waves:Causes of these waves:

‘‘a’ wavea’ wave: : RA contraction.RA contraction. ‘‘c’ wavec’ wave:: Bulging of TV into RA during Bulging of TV into RA during

isovolumetric contraction phase.isovolumetric contraction phase. ‘‘v’ wavev’ wave:: RA press due to filling of atrium RA press due to filling of atrium

with blood, (venous return.)with blood, (venous return.) ‘‘x’ descentx’ descent:: Downward displacement of TV Downward displacement of TV

during rapid ejection phase.during rapid ejection phase. ‘‘y’ descenty’ descent:: Rapid blood flow from RA to RV. Rapid blood flow from RA to RV.


Q. How to identify JVP tracing?Q. How to identify JVP tracing?

1.1. First identify ‘v’ wave, you will find two First identify ‘v’ wave, you will find two descents ‘x’ & ‘y’ on either side of ‘v’.descents ‘x’ & ‘y’ on either side of ‘v’.

2. The ‘a’ & ‘c’ wave precede the ‘x’ 2. The ‘a’ & ‘c’ wave precede the ‘x’ descent.descent.


Clinical abnormalities:Clinical abnormalities: ‘‘a’ wavea’ wave:: • Prominent:Prominent: 1. RV hypertrophy (1. RV hypertrophy ( resist of filling) resist of filling)

2. Pulmonary stenosis.2. Pulmonary stenosis. 3. Pulmonary hypertension.3. Pulmonary hypertension. 4. Tricuspid stenosis.4. Tricuspid stenosis.• Absence:Absence: Atrial fibrillation, TR.Atrial fibrillation, TR.

• Cannon wave:Cannon wave: Complete AV block, atrial flutter, Complete AV block, atrial flutter,

ventricular extrasystole.ventricular extrasystole. ‘‘c’ wavec’ wave: : Prominent in TR; absent in const.peric.Prominent in TR; absent in const.peric.

‘‘v’ wavev’ wave: : Prominent in constrictive pericarditis.Prominent in constrictive pericarditis.


Thank You

the recording of jugular venous & carotid arterial pulses

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