Question

An adult patient complains of palpitations and presents with an irregularly irregular pulse. Pulse deficit is 20, HR=120/min, in BP 110/70 mm Hg. Which of the following will be found in this patient?

• A. Absent a wave
• B. High amplitude a wave
• C. Normal a wave
• D. B wave

Hint:

In atrial fibrillation, the absence of the a wave and the presence of a pulse deficit are key clinical signs.

Answer 1

The Correct Option is A

To solve this question, we first need to understand the clinical scenario described and the options provided. The question involves recognizing the type of jugular venous pulse (JVP) wave abnormality in a patient with certain symptoms.

1. The patient has an irregularly irregular pulse and a pulse deficit. This is indicative of a possible atrial fibrillation, a common condition characterized by an irregular and often rapid heart rate.
2. Atrial fibrillation results in the absence of coordinated atrial contraction, leading to the loss of the normal atrial contribution to ventricular filling.
3. In the jugular venous pressure waveform, the "a wave" corresponds to atrial contraction. In atrial fibrillation, where there is no organized atrial contraction, the "a wave" is absent.

Let's review the options:

• Absent a wave: This matches the expected finding in atrial fibrillation due to the lack of atrial contraction.
• High amplitude a wave: This occurs when there is high resistance to right atrial emptying, as seen in conditions like tricuspid stenosis or pulmonary hypertension, not in atrial fibrillation.
• Normal a wave: Expecting a normal "a wave" would not align with the irregular, fibrillating atria in atrial fibrillation.
• B wave: This term typically does not refer to a standard component of the venous pulse wave in this context.

Therefore, the correct answer is Absent a wave, as atrial fibrillation leads to the absence of coordinated atrial contraction, eliminating the "a wave" from the JVP.