THE INTERPRETATION WITH THE POSITIVE VENOUS PULSE. 2.
ALBION WALT HEWVLETT, M. D.
(Assistant Professor of AMedicine at thze Cooper Medical School, San Francisco, Cal. )
The normal venous pulse is usually characterized by the existence of two primary waves. The first of these kinds of, the a wave, is caused by the contractioni of the proper auricle, and immediately precedes the carotid pulse. The other, or v trend, appears in the neck at the begining of diastole coincident with the closure of the semilunar valves. ' It stems, however , by a to some degree earlier period, for about. I second is usually lost by this wave in traveling through the heart to the neck. two It is probably caused by an upward activity of the auriculo-ventricular junction towards the end of systole. The versus wave is generally notched and several believe that the portion earlier the step is a stasis wave due to the collection of blood inside the auricle previous to ventricular diastole. ' A lot of authors, several indeed, attribute the entire sixth is v wave to this origin. This wave is terminated by the opening in the trictuspid valves and the accompanying flow of blood from your right auricle into the proper ventricle. It will be noted to sum up description of the normal venous pulse there is a negative downward phase extending from the end of auricular systole to nearly the conclusion of ventricular systole. This can be frequently to some extent obscured in tracings by simply an extraneous third trend due to the carotid pulse. Giving this latter out of account, the negative stage occurring through the first two-thirds of ventricular systole is one of the most feature features of the normal venous pulse. This bad phase implies a relatively quick emptying from the venous blood into the cardiovascular system; and Assurer 4 offers demonstrated experimentally that the venous flow is more rapid during ventricular systole than any kind of time other portion of the heart failure cycle. In the event one may assess the *Received for publication Aug. 20, I907.
rate of flow in man in the depth in the negative wave, then it is usual in him likewise for the most quick venious flow to occur during ventricular systole. This is especially and so during rapid heart action when the stop between the end of ventricular systole and the beginning of the following auricular contraction is most shortened. The quicker flow of blood toward the cardiovascular during ventricular systole is due in part to auricular diastole and in part to the downwards movement of the auriculo-ventricular septum at this time. The term " confident venous pulse" has been utilized by some to indicate a regurgitant venous pulsation, due to a stream of blood having back into the veins through the heart. It is often contrasted while using venous pulsations caused by an intermittent disruption of the circulation toward the heart, the so-called " negative venous pulse. " In order to separate these two forms of pulsation it has been recommended which the external jugular vein be compressed in its center. Whether it still pulsated when all flow from above was shut off, a regurgitant pulse was believed to be present; whereas in the event the cutting off in the flow previously mentioned stopped the pulse we were dealing with a bad pulse. Sadly in practice it truly is by no means easy to satisfy one's self as to the effect of impeding the vein in its middle section, nor are the data thus obtained a vast amount of value. The externial jugular vein in normal pets or animals continues to throb below a ligature. five Furthermore, a regurgitant venous pulse will not necessarily suggest tricuspid deficiency. It may be due to the effective contractions of any right auricle, provided just how from the auricle to the problematic veins is not really obstructed by simply competent venous valves neither by the muscle closure of the caval starting into the right auricle. Riegel I in i 88 i plainly pointed out these objections to the present method of analyzing the venous pulse and showed the. important difference between the typical venous heart beat and that of tricuspid deficiency...
References: i906, 17514. Hering, H. At the. Ueber pass away hiiufige Kombination von Kammervenenpuls mit Pulsus irregularis perpetuus Deut. mediterranean sea. Wochenschr, 1906,