About Video

This is a recording from a patient with rheumatic heart disease who had received a prosthetic mitral valve replacement. Two clips are shown. One with the patient reclining and in the second clip the patient is sitting upright. The jugular movements transmitted to the skin overlying the sternomastoid are easily seen. The simultaneously recorded heart sounds show prosthetic valve closure sound causing the S1, the normal S2 followed quickly by an opening click (OC) of the prosthetic valve. The S2-OC is audible as a split sound. One single descent is seen with each cardiac cycle and it occurs after the S2 and the OC. This will be therefore diastolic and will represent a single y descent. The wave preceding the y descent will be the v wave. The v wave is seen to rise quite prominently as well with each cardiac cycle. This is particularly visible in the second clip with the patient sitting up. The entire sternomastoid muscle and the overlying skin gets pushed up with each cycle. The v wave is therefore very prominent unlike the normal v wave whose rise is poorly seen. This is diagnostic of tricuspid regurgitation. The pulsations are so prominent it would perhaps be visible from the foot end of the bed or from a distance of several feet. Note unlike the prominent a wave seen in the previous patient, the v wave has a longer duration. If one were to feel the radial pulse or the carotid pulse at the bedside of the patient, the v wave would be seen to come with the pulse but would last much longer beyond the duration of the pulse. In patients with chronic heart failure, one may see the jugular contour of single y descent especially when the patient is in atrial fibrillation. However, it will be unlike tricuspid regurgitation since the jugular movements in patients with heart failure will not be so prominently visible from a distance.