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IMAGES IN MEDICINE
Year : 2018  |  Volume : 31  |  Issue : 5  |  Page : 310

Prominent CV wave in severe tricuspid regurgitation


Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Date of Web Publication24-Jun-2019

Correspondence Address:
Sanjay Ganapathi
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-258X.261181


How to cite this article:
Mohanan Nair KK, Ganapathi S, Gopalakrishnan A, Valaparambil A. Prominent CV wave in severe tricuspid regurgitation. Natl Med J India 2018;31:310

How to cite this URL:
Mohanan Nair KK, Ganapathi S, Gopalakrishnan A, Valaparambil A. Prominent CV wave in severe tricuspid regurgitation. Natl Med J India [serial online] 2018 [cited 2019 Jul 22];31:310. Available from: http://www.nmji.in/text.asp?2018/31/5/310/261181



A 50-year-old man was admitted with progressively worsening dyspnoea for 1 month. He was in atrial fibrillation with fast ventricular rate and heart failure. The upper limb blood pressure was 110/80 mmHg. The jugular venous pressure was elevated with prominent cv wave visible in the sitting position (video available at www.nmji.in). Cardiovascular examination revealed cardiomegaly and grade 2/6 holosystolic murmur in the left lower sternal border increasing on inspiration. He had tender hepatomegaly with systolic hepatic pulsations. Normal vesicular breath sounds were noted bilaterally without adventitious sounds. Chest X-ray revealed gross cardiomegaly with right atrial (RA) enlargement [Figure 1]a. Echocardiogram showed rheumatic tricuspid valve with severe tricuspid regurgitation (TR) due to non-coaptation of tricuspid valve leaflets [Figure 1]b. Right heart catheterization revealed elevated RA mean pressure and prominent cv wave.
Figure 1:(a) Chest X-ray showing gross cardiomegaly with features of right atrial enlargement (b) Echocardiographic demonstration of severe tricuspid regurgitation due to non-coaptation of tricuspid valve leaflets, right ventricle

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Normally, jugular venous pulse is characterized by 3 positive waves—a wave (reflecting atrial systole), c wave (reflecting rise in atrial pressure owing to ascent of closed tricuspid valve during isovolumetric contraction phase) and v wave (reflecting atrial filling during late systole) and 2 descents—X descent (reflecting atrial diastole) and Y descent (reflecting passive ventricular filling during early diastole). In severe TR, X descent disappears and c wave will be fused with prominent v wave creating a prominent cv wave. His heart failure was stabilized with digoxin, loop diuretics and aldosterone antagonists.

Conflicts of interest. None declared




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