<prompt> Giant a waves in JVP occur in all exceptJunctional rhythmsTricuspid regurgitation TRPulmonary HTNComplete heart block  <response>: Ans. b TR. Ref. Harrison, Principles of Medicine, 18lhChapter 227.JVP: It has 3 positive and 2 negative waves. Right IJV is best to estimate JVP.1.A positive waveIs due to venous distension due to RA contraction. Large a waves-TS, pulmonary hypertension, PS, arrhythmia Cannon a waves -Irregular -CHBAV dissociation with ventricular tachycardia. Cannon a waves -Regular -junctional rhythm, Absent a wave -AF. Increased delay between a wave and carotid pulse -primary AV block.2.C wave positive wavebulging of tricuspid valve into RA during RV isovolumetric systole and by impact of CCA adjacent to JVC. AIIMS 2007 Nov3.X descent negative waveoccurs due to both, atrial relaxation and downward displacement of tricuspid valve during systole. Accentuated -constrictive pericarditis Reduced nadir -RV dilatation Reversed C -TR.4.V wave positive waveincreasing volume of blood in RA during ventricular systole when tricuspid valve is closed. Prominent v wave -TR Combination of prominent V wave obliteration of X descent single large positive sinusoidal wave5.Y descent negative waveThe negative descending limb produced by opening of tricuspid valve and subsequent rapid inflow of blood in RV. Rapid Y descent -severe TR Sharp Y descent, deep Y through and rapid ascent to base line -constrictive pericarditis or right sided heart failure. Slow Y descent -TS or RA myxoma.6.Kussmauls signincrease, rather than decrease in CVP during inspiration, seen in right sided heart failure Constrictive pericarditis and RV infarction. Sharp Y descent is known as Freidrichs sign. 