1. The Recording of Jugular Venous & Carotid Arterial Pulses

2. Dr. Abeer Cardiovascular Practical 2 Objectives:  To be able to: identify, identify, understand the events causing the different waves of the JVP & CP tracings. understand the events causing the different waves of the JVP & CP tracings.

3. Dr. Abeer Cardiovascular Practical 3 A. The Carotid Arterial Pulse  Method: 1. Subject lies quietly on a couch. 2. Feel CAP on medial side of sternomastoid muscle. 3. Apply transducer over CA using soft rubber band & connect it to recorder.

4. Dr. Abeer Cardiovascular Practical 4 Pulse: Record of pressure changes created by ejection of blood from LV into already full aorta & is propagated as a wave over the vessel wall.

5. Dr. Abeer Cardiovascular Practical 5 Recorded CAP graph:  Anacrotic limb: - Record during maximum ejection phase - Record during maximum ejection phase of ventricular systole. of ventricular systole.  Dicrotic notch (Incisura): - Due to closure of aortic valve. - Due to closure of aortic valve.  Dicrotic wave: - Due to elastic recoil of arterial wall. - Due to elastic recoil of arterial wall.  Dicrotic limb: (descending)

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7. Dr. Abeer Cardiovascular Practical 7  Cardiac Cycle duration = 0.8 sec.  Ventricular systole = 0.3 sec.  Ventricular diastole = 0.5 sec.

8. Dr. Abeer Cardiovascular Practical 8  Aortic Stenosis:  - Slow rising pulse, small volume, late systolic peak. - Slow rising pulse, small volume, late systolic peak.  Shock or dehydration:  - weak or thready pulse, due to  volume. - weak or thready pulse, due to  volume.  Aortic Regurgitation:  - Collapsing pulse (water hummer). Collapsing = - Collapsing pulse (water hummer). Collapsing = Diastolic leak back to Lt. ventricle. Rapid up stroke (  Diastolic leak back to Lt. ventricle. Rapid up stroke (  stroke volume &  pulse wave). stroke volume &  pulse wave).  Hypertension:  - Bounding pulse, due to good volume. - Bounding pulse, due to good volume.  Pregnancy:  (N) - due to good volume. - due to good volume. Clinical abnormalities:

9. Dr. Abeer Cardiovascular Practical 9 B. The Jugular Venous Pulse  Method: 1. Subject performs Valsalva manoeuvre (deep inspiration followed by forced expiration against closed glottis), internal jugular vein will be prominent. 2. Choose position on the IJV away from CA. 3. Place pulse transducer over the vein & keep it in position with self adhesive plaster. 4. Connect to recorder.

10. Dr. Abeer Cardiovascular Practical 10  Pressure changes in RA can be recorded from IJV as there are no valves between them.  The EJV can’t be relied because it: 1. has valves, 2. ? obstructed by facial & muscular layers through which it passes.  JVP  in: 1. Rt. Sided heart failure. 2. Fluid overload.

11. Dr. Abeer Cardiovascular Practical 11 Recorded JVP graph:  Upward deflection: a, c, & v waves. a, c, & v waves.  Downward deflection: x & y descents. x & y descents.

12. Dr. Abeer Cardiovascular Practical 12 Causes of these waves:  ‘a’ wave: RA contraction.  ‘c’ wave: Bulging of TV into RA during isovolumetric contraction phase. isovolumetric contraction phase.  ‘v’ wave:  RA press due to filling of atrium with blood, (venous return.) with blood, (venous return.)  ‘x’ descent: Downward displacement of TV during rapid ejection phase.  ‘y’ descent: Rapid blood flow from RA to RV.

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14. Dr. Abeer Cardiovascular Practical 14 Q. How to identify JVP tracing? 1.First identify ‘v’ wave, you will find two descents ‘x’ & ‘y’ on either side of ‘v’. 2. The ‘a’ & ‘c’ wave precede the ‘x’ descent.

15. Dr. Abeer Cardiovascular Practical 15 Clinical abnormalities:  ‘a’ wave: Prominent: 1. RV hypertrophy (  resist of filling) Prominent: 1. RV hypertrophy (  resist of filling) 2. Pulmonary stenosis. 2. Pulmonary stenosis. 3. Pulmonary hypertension. 3. Pulmonary hypertension. 4. Tricuspid stenosis. 4. Tricuspid stenosis. Absence: Atrial fibrillation, TR. Absence: Atrial fibrillation, TR. Cannon wave: Complete AV block, atrial flutter, Cannon wave: Complete AV block, atrial flutter, ventricular extrasystole. ventricular extrasystole.  ‘c’ wave: Prominent in TR; absent in const.peric.  ‘v’ wave: Prominent in constrictive pericarditis.

16. Dr. Abeer Cardiovascular Practical 16 Thank You