JUGULAR VENOUS PULSATION (JVP)

Jugular venous distention develops in right-sided heart failure, constrictive pericarditis, pericardial tamponade, obstruction of superior vena cava. JVP normally falls with inspiration but may rise (Kussmaul sign) in constrictive pericarditis. Abnormalities in examination include:

Large “a” wave: Tricuspid stenosis (TS), pulmonic stenosis (PS), atrioventricular (AV) dissociation (right atrium contracts against closed tricuspid valve)
Absent “a” wave: Atrial fibrillation
Large “v” wave: Tricuspid regurgitation, atrial septal defect
Steep “y” descent: Constrictive pericarditis
Slow “y” descent: TS

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