Interpretation of the Positive Venous Pulse
THE INTERPRETATION OF THE POSITIVE VENOUS PULSE.*
ALBION WALTER HEWVLETT, M.D.
(Assistant Professor of AMedicine at thze Cooper Medical College, San Francisco, Cal.)
INTRODUCTION.
The normal venous pulse is characterized by the presence of two main waves. The first of these, the a wave, is due to the contractioni of the right auricle, and immediately precedes the carotid pulse. The other, or v wave, appears in the neck in early diastole coincident with the closure of the semilunar valves. ' It originates, however, at a somewhat earlier period, for about . I second is lost by this wave in traveling from the heart to the neck.2 It is probably caused by an upward movement of the auriculo-ventricular junction at the end of systole. The v wave is frequently notched and many believe that the portion preceding the notch is a stasis wave caused by the collection of blood in the auricle previous to ventricular diastole. ' Some authors,3 indeed, attribute the entire v wave to this origin. This wave is terminated by the opening of the trictuspid valves and the consequent flow of blood from the right auricle into the right ventricle. It will be noted from the above description of the normal venous pulse that there is a negative downward phase extending from the end of auricular systole to nearly the end of ventricular systole. This is frequently somewhat obscured on tracings by an extraneous third wave due to the carotid pulse. Leaving this latter out of account, the negative phase occurring during the first two-thirds of ventricular systole is one of the most characteristic features of the normal venous pulse. This negative phase indicates a relatively rapid emptying of the venous blood into the heart; and Porter 4 has demonstrated experimentally that the venous flow is more rapid during ventricular systole than at any other portion of the cardiac cycle. If one may judge the
*Received for publication Aug. 20, I907.
("9)
I120
HEWLETT. *
rate of flow in
ALBION WALTER HEWVLETT, M.D.
(Assistant Professor of AMedicine at thze Cooper Medical College, San Francisco, Cal.)
INTRODUCTION.
The normal venous pulse is characterized by the presence of two main waves. The first of these, the a wave, is due to the contractioni of the right auricle, and immediately precedes the carotid pulse. The other, or v wave, appears in the neck in early diastole coincident with the closure of the semilunar valves. ' It originates, however, at a somewhat earlier period, for about . I second is lost by this wave in traveling from the heart to the neck.2 It is probably caused by an upward movement of the auriculo-ventricular junction at the end of systole. The v wave is frequently notched and many believe that the portion preceding the notch is a stasis wave caused by the collection of blood in the auricle previous to ventricular diastole. ' Some authors,3 indeed, attribute the entire v wave to this origin. This wave is terminated by the opening of the trictuspid valves and the consequent flow of blood from the right auricle into the right ventricle. It will be noted from the above description of the normal venous pulse that there is a negative downward phase extending from the end of auricular systole to nearly the end of ventricular systole. This is frequently somewhat obscured on tracings by an extraneous third wave due to the carotid pulse. Leaving this latter out of account, the negative phase occurring during the first two-thirds of ventricular systole is one of the most characteristic features of the normal venous pulse. This negative phase indicates a relatively rapid emptying of the venous blood into the heart; and Porter 4 has demonstrated experimentally that the venous flow is more rapid during ventricular systole than at any other portion of the cardiac cycle. If one may judge the
*Received for publication Aug. 20, I907.
("9)
I120
HEWLETT. *
rate of flow in
References: i906, 17514. Hering, H. E. Ueber die hiiufige Kombination von Kammervenenpuls mit Pulsus irregularis perpetuus Deut. med. Wochenschr, 1906, 213.