Jugular Venous Waveform in Atrial Fibrillation
The jugular venous pulse can provide a clue to the diagnosis of atrial fibrillation. The a wave of the jugular venous waveform occurs as a result of right atrial contraction. Because atrial fibrillation does not allow for coordinated atrial contraction, the a wave disappears. Similarly, since there is no atrial relaxation in the setting of atrial fibrillation, the x descent is smaller than normal.
Patient 1:
This patient was admitted to the hospital with decompensated heart failure and atrial fibrillation. These videos demonstrate the typical features of the jugular venous waveform of atrial fibrillation: it is irregular, there is no a wave, and there is a diminutive x descent. The single dominant descent shown in these videos is the y descent. You could prove that at the bedside by observing the jugular venous pulse while simultaneously ausculting the heart or palpating the pulse. The x descent occurs at the same time as S1 and the peripheral pulse, while the y descent does not.
Jugular Venous Waveform in Atrial Fibrillation
Annotated
Patient 2:
This patient has atrial fibrillation.
Jugular Venous Waveform in Atrial Fibrillation