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.
Patient 1:
A healthy young woman volunteered to have her neck examined. She has a normal jugular venous pressure and waveform.
*It may be easier to appreciate this video by slowing it down to half speed (click the gear icon in the bottom right corner of the video)
Normal Jugular Venous Pressure
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Narrated
Patient 2:
A healthy young woman volunteered to have her neck examined. She has a normal jugular venous pressure and waveform.
*It may be easier to appreciate this video by slowing it down to half speed (click the gear icon in the bottom right corner of the video)
Normal JVP
Annotated
Patient 3:
This young patient was admitted to the hospital for an unrelated condition. She was noted to have a normal jugular venous pressure and waveform. A long swab tip can be used at the bedside to allow for easier visualization of pulsations and other movements.
*It may be easier to appreciate this video by slowing it down to half speed (click the gear icon in the bottom right corner of the video)
JVP with Q tip
Annotated