<prompt> Giant V wave on examination of the jugular venous pulse is suggestive of :Atrial flutter with changing blockTricuspid incompetenceVentricular septal defectPulmonary stenosis  <response>: Giant v waves indicate the presence of tricuspid regurgitation. The jugular venous pressure should be quantified in centimeters of water normal 8 cm by estimating the height of the venous column of blood above the sternal angle in centimeters and then adding 5 cm. In the early stages of HF, the venous pressure may be normal at rest but may become abnormally elevated with sustained 1 min pressure on the abdomen positive abdominojugular reflux. ref : Harrison;s principle of internal medicine,20th edition,pg no.1905 