Question
After placing a central line in an unstable patient in the ICU, you notice the initial CVP tracing shows very prominent C–V waves. If an echocardiogram was then obtained, you might expect to find
| A. |
Cardiac tamponade
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| B. |
Significant tricuspid regurgitation
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| C. |
Atrial fibrillation
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| D. |
AV dissociation
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Show Answer
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Correct Answer � B
Explanation
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Answer- B. Significant tricuspid regurgitation
During systole in a patient with tricuspid regurgitation, part of the ejected volume flows backward into the atrium. Instead of seeing a small C wave that normally represents the bulging of the tricuspid valve, a much larger C wave would be seen as blood flows retrograde into the right atrium and toward the transducer.
This retrograde blood flow would continue throughout the systole, and would, therefore, also increase the V wave size, since this is a systolic component of the CVP trace. During cardiac tamponade, there will be elevated pressures throughout the entire waveform, as well as loss of the Y descent.
In patients with atrial fibrillation, there will be a loss of the A wave, since there is no longer a uniform atrial contraction, and an overall increase in the C wave size, since filling pressures elevate to compensate and improve ventricular filling. With AV dissociation, there are large and exaggerated A waves (often called “cannon” A waves), which represent atrial contraction against a closed tricuspid valve.
