A 34-year-old Russian immigrant comes to the physician with a 2-month history of exertional dyspnea and progressive lower extremity swelling. He also reports abdominal distension and decreased appetite. The patient has gained 4.5 kg (10 lbs) over the last 2 months. Past medical history is significant for hypertension and recurrent lung infections requiring prolonged antibiotic therapy. He has no history of coronary artery disease. The patient has smoked a pack of cigarettes daily for the past 15 years. He undergoes noninvasive cardiac testing followed by cardiac catheterization. A jugular venous pressure tracing is shown on the slide below. The waveform indicated by the arrow most likely corresponds to which of the following?

Question

A 34-year-old Russian immigrant comes to the physician with a 2-month history of exertional dyspnea and progressive lower extremity swelling.  He also reports abdominal distension and decreased appetite.  The patient has gained 4.5 kg (10 lbs) over the last 2 months.  Past medical history is significant for hypertension and recurrent lung infections requiring prolonged antibiotic therapy.  He has no history of coronary artery disease.  The patient has smoked a pack of cigarettes daily for the past 15 years.  He undergoes noninvasive cardiac testing followed by cardiac catheterization.  A jugular venous pressure tracing is shown on the slide below.  The waveform indicated by the arrow most likely corresponds to which of the following?

Quizplus · Accepted Answer

11ec160b_3a8d_1b24_9249_07b5746e93d6_MD0001_00 A normal jugular venous pulse wave tracing has 3 positive waves (a, c, and v) and 2 negative waves (x and y descent). The a wave (indicated by the arrow on the diagram above) is generated by atrial contraction, the c wave is caused by bulging of the tricuspid valve into the right atrium in early systole, and the v wave reflects the passive increase in pressure and volume of the right atrium as it fills in late systole and early diastole. The troughs of the jugular venous pulse are known as the x-descent and the y-descent. The x-descent is primarily caused by relaxation of the right atrium. 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. Educational objective: On jugular venous pressure tracings, the first peak is the a wave, which is generated by atrial contraction. This is notably absent in patients with atrial fibrillation.

A 34-Year-Old Russian Immigrant Comes to the Physician with a 2-Month