A 34-year-old Russian immigrant visits the doctor after complaining of exertional dyspnea and progressive lower extremity swelling for two months. He also complains of abdominal distension and a loss of appetite. Over the last two months, the patient has gained 4.5 kg (10 lbs). Past medical history is important for hypertension and recurrent lung infections that necessitate long-term antibiotic therapy. He has never had coronary artery disease. For the past 15 years, the patient has smoked a pack of cigarettes every day. He is subjected to noninvasive cardiac testing, which is followed by cardiac catheterization. The slide below depicts a jugular venous pressure tracing. The waveform indicated by the arrow most likely corresponds to which of the following?

Question

A 34-year-old Russian immigrant visits the doctor after complaining of exertional dyspnea and progressive lower extremity swelling for two months. He also complains of abdominal distension and a loss of appetite. Over the last two months, the patient has gained 4.5 kg (10 lbs). Past medical history is important for hypertension and recurrent lung infections that necessitate long-term antibiotic therapy. He has never had coronary artery disease. For the past 15 years, the patient has smoked a pack of cigarettes every day. He is subjected to noninvasive cardiac testing, which is followed by cardiac catheterization. The slide below depicts a jugular venous pressure tracing.  The waveform indicated by the arrow most likely corresponds to which of the following?

Quizplus · Accepted Answer

Eductional Objective: A typical jugular venous pulse wave trace contains three positive waves (a, c, and v) and two negative waves (x and y descent). The a wave (represented by the arrow in the diagram above) is caused by atrial contraction, the c wave by the tricuspid valve bulging into the right atrium in early systole, and the v wave by the passive increase in pressure and volume of the right atrium as it fills in late systole and early diastole. The x-descent and y-descent are the troughs of the jugular venous pulse. The x-descent is primarily caused by right atrial relaxation. The y-descent represents the abrupt decrease in right atrial pressure during early diastole after the tricuspid valve opens and the right ventricle begins to passively fill.

A 34-Year-Old Russian Immigrant Visits the Doctor After Complaining of Exertional