Contour Recognition

1. Can you see a C wave by inspection of jugular neck pulsations?

ANS: No. It is too small. The large C wave in jugular pulse tracings is due to carotid artifact because the pulse wave sensor that is used to record jugulars cannot separate out the impulse of a carotid movement, which occurs at about the same time as the tricuspid valve closure C wave. The C wave was originally thought to be entirely due to the carotid pulse, and thus the letter "C" for "carotid."

This jugular pulse tracing shows a large C wave that cannot be seen with the naked eye because it is due mostly to carotid artifact.

2. Why are the V wave and Y descent often not visible or very low in amplitude in most adults?

ANS: Because the right atrium is a very compliant or distensible chamber, i.e., the right atrium is too distensible to allow its pressure to rise very much when the tricuspid valve is closed.

II II

On the left is a normal jugular pulse tracing. On the right is the jugular pulse usually seen by the naked eye in the normal adult, i.e., one descent, the X plus X' but mainly the X'.

3. If a C wave, V wave, and Y descent are not seen in most adults, what should you look for on an adult jugular?

ANS: You should expect to see a single systolic descent consisting only of a small X plus a large X'.

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