Mechanism of Abnormal JVF Patterns and Jugular Pulse Contours in Post Cardiac Surgery Patients

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In most patients who have undergone cardiopulmonary bypass, the altered flow velocity patterns are not associated with alterations in right heart pressures. Postoperatively, the right atrium seems to behave as a conduit rather than a capacitance chamber. Its capacitance function may be attenuated initially because of edema and later probably due to stiffness caused by scarring. The loss of buffering function of the atrium as a capacitance chamber leads to full reflection of the diastolic flow velocity at the tricuspid valve to the superior vena cava and the jugulars, thus exaggerating the y descent (Fig. 19). When the flow velocity pattern was Sf < Df (x' <y descent), RV dysfunction and decreased ejection fraction was demonstrated (42) (Fig. 20).

Jugular Vein Pulsation

Fig. 18. Diagrammatic representation of the serial changes observed over time in the jugular venous pulse contour and the corresponding jugular venous flow patterns in pulmonary hypertension. as the right ventricle (RV) begins to decompensate. (Modified and reprinted from ref. 41. Copyright 2005 with permission from Excerpta Medica Inc.)

Fig. 18. Diagrammatic representation of the serial changes observed over time in the jugular venous pulse contour and the corresponding jugular venous flow patterns in pulmonary hypertension. as the right ventricle (RV) begins to decompensate. (Modified and reprinted from ref. 41. Copyright 2005 with permission from Excerpta Medica Inc.)

Post Cardiac Surgery x' = y

Walking Sequence Animation

Fig. 19. Simultaneous jugular venous pulse (JVP), the jugular venous flow velocity (JVF), phonocardiogram (phono), and electrocardiogram (ECG) in a post-cardiac surgery patient showing equal x' and y descents. This is an abnormal JVP contour. Superimposed diagrams help explain the pathophysiology. The right atrium (RA), rather than acting as a capacitance chamber, acts only as a conduit. The size of the arrows depicting flow at the tricuspid valve and at the superior vena cava (SVC) during early diastole is equal to indicate this. (Modified and reprinted from ref. 42. Copyright 2005 with permission from Excerpta Medica Inc.)

Fig. 19. Simultaneous jugular venous pulse (JVP), the jugular venous flow velocity (JVF), phonocardiogram (phono), and electrocardiogram (ECG) in a post-cardiac surgery patient showing equal x' and y descents. This is an abnormal JVP contour. Superimposed diagrams help explain the pathophysiology. The right atrium (RA), rather than acting as a capacitance chamber, acts only as a conduit. The size of the arrows depicting flow at the tricuspid valve and at the superior vena cava (SVC) during early diastole is equal to indicate this. (Modified and reprinted from ref. 42. Copyright 2005 with permission from Excerpta Medica Inc.)

Post Cardiac Surgery x'<y

Post Cardiac Surgery x'<y

Phonocardiogram Explined

Fig. 20. Simultaneous recordings of electrocardiogram (ECG), jugular venous flow velocity (JVF) and the right atrial (RA) and right ventricular (RV) pressures in a post-cardiac-surgery patient. The y descent on the RA pressure is more prominent than the X descent, with the corresponding dominant diastolic flow (Df) peak in JVF. (Reproduced with kind permission from ref. 47.)

Fig. 20. Simultaneous recordings of electrocardiogram (ECG), jugular venous flow velocity (JVF) and the right atrial (RA) and right ventricular (RV) pressures in a post-cardiac-surgery patient. The y descent on the RA pressure is more prominent than the X descent, with the corresponding dominant diastolic flow (Df) peak in JVF. (Reproduced with kind permission from ref. 47.)

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Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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