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RA/CVP Waveform Interpretation

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Central venous pressure (CVP) or right atrial pressure (RAP) waveform tracings can often times provide useful insight about a patient’s right ventricle (RV), tricuspid valve (TV), and overall cardiopulmonary status. The waveform morphology is easier to identify at slower heart rates and consists of three waves and two descents:

  • ‘a’ wave (RA contraction at end diastole): lost in atrial fibrillation/flutter due to disorganized atrial activity. ↑ in pathologies that impede forward flow like tricuspid/pulmonic stenosis and pHTN. Classic “cannon waves” caused by RA contraction against a closed TV causing reflection wave back into RA (junctional rhythm, V-tach, third degree block)
  • ‘c’ wave (TV cusps bulge into RA during early systole): c-v wave fusion and blunting of ‘x’ descent with TR
  • ‘x’ descent (RA relaxation in mid systole): ↑ in constrictive pericarditis (CP), ↓ with TR (jet ↑ RAP) and RV dysfunction due to ↓ downward movement of RV
  • ‘v’ wave (rapid filling of RA in late systole). ↑ in TR from regurgitant jet ↑ RAP. Similar tracings obtained for LEFT atrial pressures (↑ ‘v’ wave with mitral regurgitation). Success of mitral valve repair (ie, MitraClip) can be partly gauged by ↓ in ‘v’ wave.
  • ‘y’ descent (rapid RV filling in early diastole) Steep ↑ with constrictive pericarditis and ↓ with tamponade (↓ RV filling from ↓ caval inflow).

Drop me a comment with your thoughts and questions!

7 Comments

  1. Le Minh Khoi Reply

    Thank you for or very nice diagram.
    Just one question: why were the elements of atrial wave named A, C, V, X descent and Y descent? Is there any glue to remember them correctly (for example: A wave for Atrial contraction).

    • Thanks Le! I actually have no idea where the letters came from. In the diagram, I underlined words that remind me of what the letter stands for (ie, the ‘c’ wave represents tricuspid valve cusps bulging into the right atrium). I couldn’t think of anything for the ‘v’ wave, so I just remember that these are the waves I monitor during MitraClip repairs to suggest that mitral regurgitation has improved.

  2. What is the cause for Prominent X and Y descent in constrictive pericarditis? Also whats the cause for Prominent x wave in cardiac tamponade?

  3. Hi! I’m a critical care nurse in Toronto, Canada and I’m wondering if I can use your diagram/infographic to help supplement the information about PA line tracings our new hires have to learn?

    Thanks so much for all the teaching that you do!

    • Hello Flavia! I’d consider it a great honor if you use this diagram for such a purpose. Thank you in advance, and please let me know if you or your new hires have questions! 🙂

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