Normal Jugular Venous Waveform

The normal jugular venous pulse is best evaluated via the right internal jugular vein, and is characterized by three peaks and two troughs. The first peak, called the a wave, results from atrial contraction during late diastole. Next, during early systole, ventricular contraction triggers closure of the tricuspid valve, producing the c wave (not visible at the bedside). In mid-systole, a combination of atrial relaxation and descent of the atrial floor during ventricular contraction results in the x descent. The third peak, the v wave, occurs as a result of atrial filling during late systole. Finally, passive ventricular filling in early diastole produces the y descent. The most conspicuous features of the venous pulse are the troughs, which generate obvious, aggressive inward movements of the skin. In the normal jugular venous waveform, the x descent is deeper than the y descent. Compared to the arterial pulse, the venous pulse involves a more diffuse area of the neck. It varies with patient positioning, respiratory cycle, and abdominal pressure (abdominojugular reflux). The normal venous pulse is not palpable.

Card Tutorial

Patient 1

A healthy young woman volunteered to have her neck examined. She has a normal jugular venous pressure and waveform.

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Normal Jugular Venous Pressure

Annotated

Narrated