Arterial and Venous Pulse (JVP)

Arterial and Venous Pulse Key guiding questions:

1. What is an arterial pulse and what causes it?
2. How does the closure of semilunar valves affect the arterial pulse?
3. What is a venous pulse and why is it mainly considered on the right side of the heart?
4. What are the different waves observed in jugular venous pulse and what do they indicate?

FOCUSSED NOTES

Arterial Pulse

• The rhythmic palpable expansion of the arterial wall due to transmission of pressure waves along the walls of the arteries that are produced during each systole of the heart.
• The rate at which the wave travels, which is independent of and much higher than the velocity of blood flow:

1. 1. 4 m/s in the aorta
   2. 8 m/s in the large arteries
   3. 16 m/s in the small arteries of young adults

• Consequently, the pulse is felt in the radial artery at the wrist about 0.1 s after the peak of systolic ejection into the aorta.
• With advancing age, the arteries become more rigid, and the pulse wave moves faster.

Arterial pulse wave form (in Aorta = Central arterial pulse)

1. Percussion wave: due to ejection of blood during ventricular systole.
2. Tidal wave: wave reflected from upper part of the body
3. Dicrotic notch: represents closure of aortIc valve.
4. Dicrotic wave: due to rebound of blood against the closed aortic valve during diastole (reflected from lower part of the body often recorded but not palpable )

Clinical Importance

• Clinically, radial pulse is examined for the assessment of arterial pulse.
• An important and essential part of the clinical examination of a patient as pulse is one of the vital signs of a
• Provides valuable information regarding the functioning of the heart, condition of hemodynamic, such as blood pressure, and the condition of blood vessels.

1. 1. The pulse is weak (“thready”) in shock.
   2. Strong when stroke volume is large (during exercise)
   3. The pulse in aortic insufficiency is called a collapsing, Corrigan, or water-hammer pulse.

Jugular Venous Pulse

• The atrial pressure changes are transmitted to the great veins, producing characteristic waves in the record of jugular pressure:

1. “A” wave: atrial contraction (ABSENT in atrial fibrillation)
2. “C” wave: ventricular contraction (tricuspid bulges).
3. “X” descent: atrial relaxation
4. “V” wave: atrial venous filling (occurs at same of time of ventricular contraction)
5. “Y” descent: ventricular filling (tricuspid opens)

• The jugular pulse waves are superimposed on the respiratory fluctuations in venous pressure.
  • Venous pressure falls during inspiration because of the increased negative intrathoracic pressure and rises again during expiration.

MCQ’s for Aretrial & Jugular Venous Pulse