Abstract
Clinical assessment of right heart function and hemodynamics is relevant for many clinical states and may aid in quick clinical decision-making. With transcutaneous bidirectional Doppler, the jugular venous flow velocity patterns have been shown to reflect right heart hemodynamics and its derangement, irrespective of the underlying etiology. Given that the peaks in the forward flow velocities in the superior vena cava and the jugulars correspond to the falling slopes of pressure waves, namely the x, x', and y descents in the right atrium, the patterns of descents in the jugular venous pulse (JVP) become clinically useful for assessment of right heart function and right heart hemodynamics. Bedside assessment of the JVP has long been focused on the rise to the peaks of these physiological waveforms. However, these studies clearly show that the descents that represent the slopes of fall to the nadir (the lowest point) actually hold useful physiological correlates. The descents in the JVP are fast movements receding from the eye fields, and therefore they can be seen easily at the bedside. These studies and long-term clinical observations have shown that the normal JVP descent pattern is single x' or x' > y, and the descent patterns of x' = y, x' < y, and single y descent alone are abnormal. The focus of this paper is to discuss in detail these JVP descent patterns, both the normal and the abnormal, with emphasis on their clinical relevance. Clinical video recordings of JVP are presented to demonstrate the key points.