The Recording of Jugular Venous

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The Recording of Jugular Venous Carotid
Arterial Pulses
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Objectives

• To be able to
• identify,
• understand the events causing the different
  waves of the JVP CP tracings.

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A. The Carotid Arterial Pulse

• Method
• Subject lies quietly on a couch.
• Feel CAP on medial side of sternomastoid muscle.
• 3. Apply transducer over CA using soft rubber
  band connect it to recorder.

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• 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.

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Recorded CAP graph

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

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

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Clinical abnormalities

• Aortic Stenosis ?
• - Slow rising pulse, small volume, late
  systolic peak.
• Shock or dehydration ?
• - weak or thready pulse, due to ? volume.
• Aortic Regurgitation ?
• - Collapsing pulse (water hummer). Collapsing
  
• Diastolic leak back to Lt. ventricle.
  Rapid up stroke (??
• stroke volume ? pulse wave).
• Hypertension ?
• - Bounding pulse, due to good volume.
• Pregnancy ? (N)
• - due to good volume.

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B. The Jugular Venous Pulse

• Method
• Subject performs Valsalva manoeuvre (deep
  inspiration followed by forced expiration against
  closed glottis), internal jugular vein will be
  prominent.
• Choose position on the IJV away from CA.
• Place pulse transducer over the vein keep it in
  position with self adhesive plaster.
• Connect to recorder.

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• Pressure changes in RA can be recorded
• from IJV as there are no valves between
• them.

• The EJV cant be relied because it
• has valves,
• ? obstructed by facial muscular layers through
  
• which it passes.

• JVP ? in
• Rt. Sided heart failure.
• Fluid overload.

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Recorded JVP graph

• Upward deflection
• a, c, v waves.
• Downward deflection
• x y descents.

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Causes of these waves

• a wave RA contraction.
• c wave Bulging of TV into RA during
• isovolumetric contraction
  phase.
• v wave ? RA press due to filling of atrium
• with blood, (venous
  return.)
• x descent Downward displacement of TV during
  rapid ejection phase.
• y descent Rapid blood flow from RA to RV.

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Q. How to identify JVP tracing?

• First identify v wave, you will find two
  descents x y on either side of v.
• 2. The a c wave precede the x descent.

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Clinical abnormalities

• a wave
• Prominent 1. RV hypertrophy (? resist of
  filling)
• 2. Pulmonary stenosis.
• 3. Pulmonary
  hypertension.
• 4. Tricuspid stenosis.
• Absence Atrial fibrillation, TR.
• Cannon wave Complete AV block, atrial flutter,
  
• ventricular
  extrasystole.
• c wave Prominent in TR absent in
  const.peric.
• v wave Prominent in constrictive pericarditis.

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Thank You