JVP

Cardiac cycle and wave forms

 JVP reflects relation between
 1.Venous tone
 2.Volume of blood in venous space
 3.Rt. Heart haemodynamics.

 Diastole : JVP directly reflects rt.

Ventricular filling pressure

 Systole : JVP reflects Rt. Atrial pressure

 Cardiac cycle
 Systole
2. Isovolumetric contraction
3. Ventricular ejection

 Diastole
6. Protodiastole
7. Isovolumetric relaxation
8. Ventricular filling phase
9. Atrial systole.
Cardiac cycle
 Isovolumetric contraction

 At the start of ventricular systole, the mitral

and tricuspid valve close.
 Ventricular muscle initially shorten little
but intra ventricular pressure rises sharply
as myocardium presses on blood on
ventricles.
 Lasts for .05 sec
 Until pressure in lt.and rt. Ventricle exceeds
pressure in aorta(80mm hg)
 Pulmonary artery (10mm hg)and aortic
and pulmonary valve open.
 During iso volumetric contraction the
AV valve bulges into atria causing a
small but sharp rise in atrial pressure
 Ventricular ejection
 When aortic and pulm valves open,phase of
ventricular ejection begins.
 Ejection is rapid at first and slows down as
systole progresses.
 Intra ventricular pressure rises to a maximum
and then declines somewhat before
ventricular systole ends.
 Peak lt. ventricular pressure is about 120mm
hg and peak rt. Ventricular pressure is 25mm
 Ventricular EDV = 130 ml.
Ventricular ESV = 50ml.
Stroke Volume (SV) = 80ml.
Ejection fraction = SV/ EDV = 65%
 DIASTOLE

Protodiastole:
 Once the ventricular muscle is fully
contracted , already falling ventricular
pressure drops more rapidly.
 Lasts about .04 sec.
 It ends when momentum of ejected blood is
overcome and aortic and pulm valve close.
 Ventricular filling phase

 During this phase blood flows from atria to

ventricle along with the pressure gradient.
 Ventricular pressure remains low.
 Atrial systole

 Contraction of atria propels some additional

blood in to ventricle.
 Accounts for about 30% of ventricular end
diastolic volume.
 CARDIAC CYCLE

SYSTOLE
 Closure of mitral and tricuspid valve-
(1st heart sound)
 Isovolumetric contraction → C wave
 Opening of aortic and pulm valve
 Ventricular ejection
 Diastole

 Protodiastole
 Closure of pulmonary and aortic valve (2nd
heart sound).
 Isovolumetric relaxation
 Opening of tricuspid and mitral valve
 Ventricular filling phase
 Atrial systole (a wave)
JVP
 Wave forms
 2 visible peaks/waves
 2 visible descents/troughs

 A wave followed by x descent

 V wave followed by y descent
 C wave is associated with a wave
 Late H wave /plateau wave terminates y
descent
 a wave

 Due to atrial systole.

 Some blood regurgitates in to great vein,
atria contracts .
 Even though orifice of great veins are
constricted
 In addition venous inflow stops and
resultant rise in venous pressure contributes
to a wave.
 a wave

 A wave follows p waves of ECG

 Precedes upstroke of carotid pulse.
 Synchronises with S1.
 X descent

 Early portion result from RA relaxation

during atrial diastole.
 Later portion is fall n Rt. Atrial pressure
during early rt. Ventricular systole , as
tricuspid ring is pulled caudally by
contracting RV.
 Begins during systole and end before S2.
 C wave

 Controversy wave/ Confusion wave

2 causes :
 a) neck veins- cwave is an artifact caused
by transmitted carotid pulse.
 b) Rt. Atrium – c wave reflects upward
bulging motion of closed tricuspid valve
during isovolumetric systole.
 This is not commonly seen.
 V wave

 Continuous venous inflow to Rt. Atrium

during ventricular systole when tricuspid
valve is closed.
 Begin late in systole and ends in early
diastole.
 Synchronous with carotid pulse and peaks
after S2
 Y descent

 When tricuspid valve opens blood enters the

rt. Ventricle rapidly.
 There is consequently lowering of Rt. Atrial
pressure.
 Begins and ends in early diastole.
 H wave

 This results from passive filling of rt.

Heart during diastole.
 Seen rarely after y descent.
 Some tips…..
 In a normal person,the a wave is larger
than v wave and x descent is more
prominent than y descent
 A wave occurs just before S1or carotid
pulse and has a sharp rise and fall
 V wave occurs just after arterial pulse and
has a slow undulating pattern
 X descent occurs between S1 and S2 and y
descent well after S2
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