The clinical value of the jugular and hepatic pulses

Abstract

We have discussed the method of examination of jugular venous pulses and hepatic pulses and the pulse waves which are normally found. Various abnormalities of the venous pulses have been described and related to the pathophysiologic states. Abnormal prominence of A waves occurs when the right atrium ejects against a greater than normal pressure at end-diastole or when the tricuspid valve is stenotic or atretic. Expansion of the venous pulse wave occurs during ventricular contraction in states of ineffectual atrial activity (atrial fibrillation, atrial flutter, some instances of atrial tachycardia) and more emphatically whenever there is incompetence of the tricuspid valve, either due to right ventricular dilatation or to a lesion of the valve proper. In constrictive pericarditis and related states of cardiac constriction, as well as when the right ventricle is distended, the general level of venous pressure is high and there is a sharp, brief collapse at end of systole. Atrial septal defect may exaggerate all of the venous pulse waves, particularly the V wave. Abnormalities of venous pulses and hepatic pulses peculiar to cardiac rhythm and rate disturbance and conduction defects have been presented. We have discussed the value of recording venous pulses in improving the accuracy of the visual and tactile examination.