Lancisi’s Sign

In the setting of severe tricuspid regurgitation, retrograde blood flow into the right atrium during ventricular systole results in loss of the x descent, creating a fused cv wave that appears as a large pulsation within the internal jugular vein. This wave is typically followed by an augmented y descent, which is the consequence of an increased pressure gradient between the right atrium and right ventricle. The often palpable cv fusion wave is one of the exceptions to the rule that the jugular venous waveform is nonpalpable. Listen for an associated holosystolic murmur over the left lower sternal border that augments with inspiration.

Card Tutorial

Patient 1

This patient has severe tricuspid regurgitation. These videos demonstrate a jugular venous waveform with CV fusion (Lancisi’s sign). Note that the large outward wave is followed by only one descent (the y descent), distinguishing it from giant a waves, in which there are two descents that follows (x and y). When auscultating the heart of a patient with Lancisi’s sign, listen for a holosystolic murmur that augments with inspiration at the left lower sternal border.