Giant 'a' waves in JVP are seen in

Question

Image below highlights jugular foramen. Which of the following structures do not pass through the marked structure “A”?

Answer 1

This question tests the link between left-sided valve disease and right-sided jugular venous findings through secondary pulmonary hypertension.

Pulmonary stenosis: a direct cause of a stiff right ventricle, but not the relationship this question is built around.
Mitral stenosis: raised left atrial pressure backs up into the pulmonary circulation, eventually raising right ventricular pressure and stiffening it, so the right atrium must contract forcefully - a giant a wave.
Complete heart block: produces irregular cannon a waves from loss of AV synchrony, not a consistent giant a wave.
Ebstein's anomaly: features tricuspid regurgitation and atrialisation of the right ventricle, giving a prominent v wave rather than a giant a wave.

Correct answer: Mitral stenosis.

Answer 2

This question tests the link between left-sided valve disease and right-sided jugular venous findings through secondary pulmonary hypertension.

Pulmonary stenosis: a direct cause of a stiff right ventricle, but not the relationship this question is built around.
Mitral stenosis: raised left atrial pressure backs up into the pulmonary circulation, eventually raising right ventricular pressure and stiffening it, so the right atrium must contract forcefully - a giant a wave.
Complete heart block: produces irregular cannon a waves from loss of AV synchrony, not a consistent giant a wave.
Ebstein's anomaly: features tricuspid regurgitation and atrialisation of the right ventricle, giving a prominent v wave rather than a giant a wave.

Correct answer: Mitral stenosis.

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