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 12

70-something year old man with severe TR. Note Lancisi’s sign as well as a holosystolic murmur over the LLSB.