Waveforms

Question 1

Why is EJV not used

Answer 1

EjV is valved and is not directly inclined with svc and ra

Question 2

A wave

Answer 2

Reflects atrial presystolic contraction
After the p wave
Precedes S1

Question 3

Prominent a wave

Answer 3

Pxs with reduced rv compliance

Question 4

Cannon a wave

Answer 4

Av dissociation and contraction against closed tricuspid valve

Pxs with wide complex tachycardias - ventricular in origin

Question 5

A wave absent

Answer 5

Af

Question 6

X descent

Answer 6

Fall in atrial pressure

atria relaxes

Question 7

C wave

Answer 7

Interrupts x descent as ventricle systole pushes on closed tv

Question 8

X descent follows C

Answer 8

Due to atrial diastolic suction created by vent systole

cont of ventricles causes more spacein pericardial sac,more space for atrium

Question 8

X descent follows C

Answer 8

Due to atrial diastolic suction created by vent systole

cont of ventricles causes more spacein pericardial sac,more space for atrium

Question 9

V wave

Answer 9

Atrial filling

Follows s2

Question 10

Why is v wave smaller than a wave

Answer 10

Normally compliant right atrium

Question 11

Explain the waveforms in ASD

Answer 11

The a and v waves may be of equal height

v - atrial filling - in asd, filled na agad atrium

Question 12

Explain waveform in TR

Answer 12

V wave will merge with c wave because of retrograde valve flow and anterograde rightbatrial filling occurs simultaneously

Question 13

Y descent

Answer 13

Follows v wave peak and reflects the fall in R atrial pressure after tricuspid valve opening

Question 14

Explain the waveform in pericardial tamponade or tricuspid stenosis

Answer 14

There is resistance in ventricular filling in early diastole BLUNTS the y descent

Question 15

Explain the waveform in pericardial constriction or isolated severe TR

Answer 15

Y descent will be steep because ventricular diastolic filling occurs early and rapidly

Question 16

Normal venous pressure should fall by _ after inspiration

Answer 16

3mm Hg..

Failure to decrease in inspiration/ increase in venous pressure upon inspiration - Kussmaul’s sign

Question 17

Where is Kussmaul’s sign seen?

Answer 17

Right sided volume overload and reduced RV compliance

Constrictive pericarditis
Restrictive cardiomyopathies
Pulmonary embolism
Rv infarction
Advanced systolic HF

Question 18

Explain the pathophysiology of Kussmaul’s sign

Answer 18

Normally, inspiratory increase in right sided venous return is accomodated by increased RV ejection facilitated by an increase in capacitance of the oulmonary vascular bed

In RV diastolic dysfunction and volume overload, RV cannot accomodate with the enhanced volume, the pressure rises.

Question 19

How to do abdominojugular reflex maneuver

Answer 19

Put a firm and consistent pressure in the right upped quadrant for at least 10 seconds

Question 20

What is a positive abdominojugular reflex

Answer 20

A rise of more than 3 cm in the venous pressure sustained for at least 15 seconds / shorter time is accepted

Avoid straining or holding breath - falsely elevated results

Question 21

What can the abdominojugular reflex predict

Answer 21

It can predict heart failure in pxs with dyspnea as well as a pulmonary wedge pressure higher than 15 mmHg