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A 67-year-old man presents to accident and emergency with a 3-day history of shortness of breath. On examination you palpate the radial pulse and notice that the patient has an irregular heart beat with an overall rate of 140 bpm. You request an electrocardiogram (ECG) which reveals that the patient is in atrial fibrillation. Which of the following would you expect to see when assessing the JVP?
ব্যাখ্যা
The JVP provides clinicians with information regarding right atrial pressures and filling. It mainly consists of five wave forms:
1 a wave - representing atrial systole;
2 c wave - representing closure of the tricuspid valve (this wave is not usually visible);
3 x descent - representing a fall in atrial pressure during ventricular systole;
4 v wave - representing atrial filling against a closed tricuspid valve;
5 y descent - representing the opening of the tricuspid valve.
In atrial fibrillation, the 'a waves' are absent (D) due to dysfunctional atrial systole. A raised JVP with normal waveform pattern (A) is usually seen in fluid overload and right heart failure. Large v waves (B) are usually seen in patients with tricuspid regurgitation. Cannon 'a waves' (C) are seen in patients with complete heart block, single chamber ventricular pacing, ventricular arrhythmias and ventricular ectopics. Large 'a waves' (E) can be seen in pulmonary hypertension and pulmonary stenosis.
1 a wave - representing atrial systole;
2 c wave - representing closure of the tricuspid valve (this wave is not usually visible);
3 x descent - representing a fall in atrial pressure during ventricular systole;
4 v wave - representing atrial filling against a closed tricuspid valve;
5 y descent - representing the opening of the tricuspid valve.
In atrial fibrillation, the 'a waves' are absent (D) due to dysfunctional atrial systole. A raised JVP with normal waveform pattern (A) is usually seen in fluid overload and right heart failure. Large v waves (B) are usually seen in patients with tricuspid regurgitation. Cannon 'a waves' (C) are seen in patients with complete heart block, single chamber ventricular pacing, ventricular arrhythmias and ventricular ectopics. Large 'a waves' (E) can be seen in pulmonary hypertension and pulmonary stenosis.