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Images In Medicine
doi: 10.4103/0970-258X.261181
PMID: 31268005

Prominent CV wave in severe tricuspid regurgitation

Krishna Kumar Mohanan Nair, Sanjay Ganapathi, Arun Gopalakrishnan, Ajitkumar Valaparambil
 Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Corresponding Author:
Sanjay Ganapathi
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala
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
Copyright: (C)2018 The National Medical Journal of India

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 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

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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