Cardiology Jugular Venous Pulse

Friedreich’s Sign

The normal jugular venous waveform contains two descents, x and y. The x descent, which corresponds to the combination of right atrial relaxation and depression of the atrial floor during ventricular contraction, is normally dominant. The y descent occurs as a result of passive ventricular filling during early diastole. A sharp and deep y descent that becomes more dominant than the x descent is known as Friedreich’s sign. It is associated with constrictive pericarditis and restrictive cardiomyopathy.

Card Tutorial

Patient 1

This patient was admitted to the hospital with cardiac tamponade. After the effusion was drained, he developed signs of pericardial constriction, including Friedreich’s sign. The cause of the pericardial effusion was never determined, but in some cases, particularly in association with tamponade, transient acute constriction can ensue for days to weeks following the initial pericardial insult as a result of reversible inflammation and edema (transient constrictive pericarditis). These videos demonstrate a sharp and deep y descent of the jugular venous waveform. Note the comparatively smaller intervening x descent, which is normally the dominant trough of the jugular venous waveform.

Video courtesy of BMJ case reports: “Friedreich’s sign”

Friedreich’s sign

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