This usually indicates poor right ventricular function. It is commonly seen in patients with chronic atrial fibrillation and congestive heart failure. When noted with a large amplitude and fast rising v wave before it, it would indicate tricuspid regurgitation. In tricuspid stenosis, the elevated v wave pressure has been described to be followed by so-called slow y descent. The slowing of the rate of fall of the y descent, even if truly present, is not usually striking enough to be detected in the jugulars (see JVP Videofiles 6 and 9 on the Companion CD).
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