Question

A patient presented with cold skin, fatigue, shortness of breath with activity and enlarged liver. His JVP was measured which showed higher amplitude of "a" wave. JVP is due to

• A. Tricuspid Regurgitation
• B. Tricuspid Stenosis
• C. Mitral Regurgitation
• D. Mitral Stenosis

Hint:

The a wave of JVP reflects right atrial contraction -- think about which valve lesion increases resistance to atrial emptying.

Answer 1

The Correct Option is B

Step 1: Understand JVP waveform components.
The JVP (jugular venous pulse) has three positive waves -- a, c, and v -- and two negative descents -- x and y.
- The a wave represents atrial systole (right atrial contraction against the tricuspid valve before it opens).
- The c wave represents tricuspid valve closure.
- The v wave represents venous filling of the right atrium while the tricuspid valve is closed.

Step 2: Determine what increases the a wave.
An elevated a wave results from increased resistance to right atrial emptying during atrial systole. This occurs when the tricuspid valve is narrowed (stenotic), forcing the right atrium to contract more forcefully against the obstruction.

Step 3: Differentiate the conditions.
- Tricuspid Stenosis: Obstructs right atrial outflow during systole -- large a wave.
- Tricuspid Regurgitation: The v wave is elevated (giant v wave) because blood regurgitates back into the right atrium during ventricular systole -- not the a wave.
- Mitral valve lesions affect left heart pressures and do not directly alter JVP waveform morphology.

Additional notes:
- Cannon a waves occur in complete heart block (AV dissociation) when the atrium contracts against a closed tricuspid valve.
- A waves are absent in atrial fibrillation (no organized atrial contraction).

Conclusion: The raised a wave in JVP is caused by Tricuspid Stenosis.