Contour Recognition

1. Can you see a C wave by inspection of jugular neck pulsations?

ANS: No. It is too small. The large C wave in jugular pulse tracings is due to carotid artifact because the pulse wave sensor that is used to record jugulars cannot separate out the impulse of a carotid movement, which occurs at about the same time as the tricuspid valve closure C wave. The C wave was originally thought to be entirely due to the carotid pulse, and thus the letter "C" for "carotid."

This jugular pulse tracing shows a large C wave that cannot be seen with the naked eye because it is due mostly to carotid artifact.

2. Why are the V wave and Y descent often not visible or very low in amplitude in most adults?

ANS: Because the right atrium is a very compliant or distensible chamber, i.e., the right atrium is too distensible to allow its pressure to rise very much when the tricuspid valve is closed.


On the left is a normal jugular pulse tracing. On the right is the jugular pulse usually seen by the naked eye in the normal adult, i.e., one descent, the X plus X' but mainly the X'.

3. If a C wave, V wave, and Y descent are not seen in most adults, what should you look for on an adult jugular?

ANS: You should expect to see a single systolic descent consisting only of a small X plus a large X'.

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