Lancisi’s Sign
In the setting of severe tricuspid regurgitation, retrograde blood flow into the right atrium during ventricular systole results in loss of the x descent, creating a fused cv wave that appears as a large pulsation within the internal jugular vein. This wave is typically followed by an augmented y descent, which is the consequence of an increased pressure gradient between the right atrium and right ventricle. The often palpable cv fusion wave is one of the exceptions to the rule that the jugular venous waveform is nonpalpable. Listen for an associated holosystolic murmur over the left lower sternal border that augments with inspiration.
Patient 1:
This patient has severe tricuspid regurgitation. These videos demonstrate a jugular venous waveform with CV fusion (Lancisi’s sign). Note that the large outward wave is followed by only one descent (the y descent), distinguishing it from giant a waves, in which there are two descents that follows (x and y). When auscultating the heart of a patient with Lancisi’s sign, listen for a holosystolic murmur that augments with inspiration at the left lower sternal border.
Patient 2:
This patient developed severe tricuspid regurgitation as a result of dilated cardiomyopathy and pulmonary hypertension. These videos demonstrate a jugular venous waveform with CV fusion (Lancisi’s sign). Notice involvement of the facial vein that crosses over the jawline.
Lancisi’s Sign
Annotated
Patient 3:
This patient developed severe tricuspid regurgitation after injury to the valve during a right heart catheterization procedure. These videos demonstrate a jugular venous waveform with CV fusion waves (Lancisi’s sign). Note the impressive y descent, which is augmented as a result of the increased pressure gradient between the right atrium and right ventricle generated by retrograde blood flow into the right atrium during ventricular systole.
Lancisi’s Sign
Annotated
Patient 4:
This patient has severe tricuspid regurgitation.
This patient also has a lateral (side-to-side) head bob.
Patient 5:
This patient has severe tricuspid regurgitation.
This patient also has tricuspid valve prolapse with a late systolic “honk” murmur over the left lateral sternal border.
Patient 6:
This patient developed severe tricuspid regurgitation as a result of dilated cardiomyopathy and pulmonary hypertension.
Lancisi’s Sign
Annotated
Patient 7:
This patient has severe tricuspid regurgitation.
Patient 8:
This is a middle-aged woman with severe tricuspid regurgitation.
Patient 9:
This is a middle-aged woman with severe tricuspid regurgitation from dilated cardiomyopathy (thought to be related to thyrotoxicosis).
Patient 10:
This is a middle aged man with radiation-induced valvular heart disease, including severe tricuspid regurgitation.