Jugular venous X descent

[jqueb29]

FA page 270 is really confusing me right now. It says the X descent is "Absent in tricuspid regurgitation. Prominent in tricuspid insufficiency and right HF."

The part about it being absent in tricuspid regurg makes perfect sense to me. But then the second sentence is nonsense to me. Pretttty sure regurg and insufficiency are the exact same thing. Are they saying that both of these individually each cause prominent X descent, or the combination of tricuspid insufficiency and RHF together cause it?

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[aspiringmd1015]

JVP overall confuses me, not the phsyiological jvp, but the pathological changes associated with it. i wonder how frequent they come on the real deal

 

[AZ7]

FA page 270 is really confusing me right now. It says the X descent is "Absent in tricuspid regurgitation. Prominent in tricuspid insufficiency and right HF."

The part about it being absent in tricuspid regurg makes perfect sense to me. But then the second sentence is nonsense to me. Pretttty sure regurg and insufficiency are the exact same thing. Are they saying that both of these individually each cause prominent X descent, or the combination of tricuspid insufficiency and RHF together cause it?

Did you find an answer ?
Or is this just an errata?

 

[Phloston]

I'm not looking at FA in front of me and can't verify what it even says, but I'll work with you here and take an improvised stab.

The x-descent should ordinarily reflect maximal RA relaxation following the atrial kick, despite venous return increasing RA volume coinciding with maximal RV contraction during RV systole.

Retrograde flow in tricuspid regurg would arguably attenuate the x-descent secondary to intra-atrial volume augmentation, such that additional volume increases RA pressure.

In RHF, I'd suggest the RV's capacity to pump retrogradely is drastically reduced because of systolic dysfunction, even if the tricuspid valve is incompetent. So the x-descent could foreseeably be present in RHF in the presence of tricuspid incompetence. And perhaps if you attenuate the positive deflection of the c-wave because the RV has systolic dysfunction, then the net nadir of the x-descent is of greater negative magnitude.

It's also possible the appearance of the x-descent may appear to be accentuated if the crest of a is amplified by the need for a strengthened kick against a stiffer RV when RA afterload is increased in RHF.

I agree that regurg = incompetence for all intents and purposes. But regurgitation might not occur across an incompetent atrioventricular valve if ventricular systolic dysfunction is of salience. I think incompetence gives rise to regurg and therefore implies it, but doesn't mandate it from a physiologic standpoint.

 

[faisal 2000]

why there is Blunted or absent Y descent in cardiac tamponade and Prominent X and Y descent in Constrictive Pericarditis ?

 

[AZ7]

why there is Blunted or absent Y descent in cardiac tamponade and Prominent X and Y descent in Constrictive Pericarditis ?

In Tamponade, active pressure is being exerted on the heart throughout the cardiac cycle. The pericardial pressure exceeds the diastolic pressure, leading to decreased filling pressure gradient. This results in a blunted or absent Y descent.
In Constrictive Pericarditis, the pericardium is rigid and can't move inwards or outwards properly. During the cardiac cycle, the ventricle is constricted after its systole but pericardium has not moved with it. Therefore there is lots of room in between and there is minimal pressure at the start of diastole. This leads to rapid ventricular filling as no resistance is offered to the expanding ventricle. This results in a prominent Y descent.

 

[Phloston]

In Tamponade, active pressure is being exerted on the heart throughout the cardiac cycle. The pericardial pressure exceeds the diastolic pressure, leading to decreased filling pressure gradient. This results in a blunted or absent Y descent.
In Constrictive Pericarditis, the pericardium is rigid and can't move inwards or outwards properly. During the cardiac cycle, the ventricle is constricted after its systole but pericardium has not moved with it. Therefore there is lots of room in between and there is minimal pressure at the start of diastole. This leads to rapid ventricular filling as no resistance is offered to the expanding ventricle. This results in a prominent Y descent.

Nice. I had wondered about this and had developed my own rationales/mechanisms but never formally looked it up.