Question

A patient presented with cold skin, fatigue, shortness of breath with activity and enlarged liver. His JVP was measured which showed higher amplitude of "a" wave. JVP is due to

• A. Tricuspid Regurgitation
• B. Tricuspid Stenosis
• C. Mitral Regurgitation
• D. Mitral Stenosis

Hint:

The a wave of JVP reflects right atrial contraction -- think about which valve lesion increases resistance to atrial emptying.

Answer 1

The Correct Option is B

JVP Waveform Analysis:
The jugular venous pulse reflects right heart pressures. The three upward deflections are:
- $a$ wave: right atrial contraction (presystolic)
- $c$ wave: tricuspid valve closure
- $v$ wave: venous filling during ventricular systole

Causes of prominent $a$ wave:
Any condition that increases resistance to right atrial outflow (i.e., makes the right atrium work harder during systole) will increase the amplitude of the $a$ wave. Tricuspid Stenosis narrows the valve orifice, so the right atrium contracts forcefully to push blood through, producing a large $a$ wave.

Why not Tricuspid Regurgitation?
In tricuspid regurgitation, blood leaks back into the right atrium during ventricular systole -- this raises the $v$ wave (giant $v$ wave / cv fusion), not the $a$ wave.

Mitral valve lesions affect the left heart and do not alter JVP morphology directly.

Answer: \[\boxed{\text{Tricuspid Stenosis}}\]