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Difficulty: HardCardiovascular System

Match each characteristic hemodynamic profile or physical examination finding with the most likely underlying cardiovascular pathology.

  • Constrictive pericarditisProminent 'y' descent in the jugular venous pulse and a failure of the jugular venous pressure to fall during inspiration (Kussmaul sign)
  • Ventricular tachycardia with atrioventricular dissociationIntermittent, prominent 'a' waves in the jugular venous pulse (cannon 'a' waves)
  • Severe tricuspid regurgitationProminent systolic 'c-v' wave in the jugular venous pulse obliterating the 'x' descent
  • Cardiac tamponadeDecrease in systolic blood pressure of >10 mm Hg during inspiration (pulsus paradoxus) and an absent 'y' descent in the jugular venous pulse
  • Severe aortic stenosisSlow-rising, low-amplitude arterial pulse (pulsus parvus et tardus)

Answer

Constrictive pericarditis matches with prominent 'y' descent and Kussmaul sign. Ventricular tachycardia with AV dissociation matches with cannon 'a' waves. Severe tricuspid regurgitation matches with 'c-v' waves obliterating the 'x' descent. Cardiac tamponade matches with pulsus paradoxus and an absent 'y' descent. Severe aortic stenosis matches with pulsus parvus et tardus.
Each cardiovascular pathology produces distinct hemodynamic changes. Cardiac tamponade compresses the heart throughout diastole, obliterating the 'y' descent, and increases ventricular interdependence, causing pulsus paradoxus. Constrictive pericarditis allows rapid early diastolic filling before an abrupt halt, producing a steep 'y' descent, and impairs right-sided adaptation to inspiration (Kussmaul sign). Severe tricuspid regurgitation causes ventricular blood to flow back into the right atrium during systole, replacing the 'x' descent with a prominent 'c-v' wave. AV dissociation (as seen in ventricular tachycardia) leads to the right atrium occasionally contracting against a closed tricuspid valve, generating intermittent cannon 'a' waves. Severe aortic stenosis restricts left ventricular outflow, resulting in a delayed, low-amplitude arterial pulse (pulsus parvus et tardus).

Step-by-Step Solution

1
Analyze the jugular venous pulse (JVP) descents.
Identify that an absent 'y' descent indicates restricted filling throughout all of diastole (cardiac tamponade), while a prominent 'y' descent with Kussmaul sign indicates restricted late diastolic filling but rapid early filling (constrictive pericarditis).
Differentiating pericardial diseases relies heavily on venous waveform hemodynamics.
2
Evaluate the positive systolic waves in the JVP.
Recognize that 'c-v' waves represent regurgitant flow (tricuspid regurgitation) and cannon 'a' waves represent atrial contraction against a closed valve (AV dissociation).
Timing of abnormal positive waves correlates with specific structural or electrical anomalies.
3
Assess the arterial pulse contour descriptions.
Match the exaggerated inspiratory drop in blood pressure (pulsus paradoxus) to tamponade, and the delayed, low-amplitude pulse (pulsus parvus et tardus) to aortic stenosis.
Arterial waveforms reflect left heart mechanics and stroke volume dynamics.

Key Concept

Cardiovascular hemodynamics and pulse contours
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Topics

Cardiovascular System

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