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Berheim "a" wave: obstructed right ventricular inflow or atrial cross talk?
M Y Henein1, H B Xiao, S J Brecker
1Cardiac Department, Royal Brompton National Heart and Lung Hospital, London.
British Heart Journal
|May 1, 1993
Summary
In patients with left ventricular hypertrophy and a dominant jugular venous "a" wave, right ventricular filling is normal. This suggests atrial interaction may cause the Bernheim "a" wave, not right ventricular inflow issues.
Area of Science:
- Cardiology
- Physiology
Background:
- The jugular venous pulse (JVP) provides insights into cardiac hemodynamics.
- Left ventricular hypertrophy (LVH) can alter cardiac filling and pressure dynamics.
- A dominant 'a' wave in the JVP, known as the Bernheim 'a' wave, is observed in some LVH patients, but its mechanism is unclear.
Purpose of the Study:
- To investigate the underlying mechanisms of the dominant 'a' wave in the jugular venous pulse in patients with left ventricular hypertrophy (Bernheim 'a' wave).
Main Methods:
- Prospective study involving 23 patients with LVH and a dominant JVP 'a' wave, compared to 21 healthy controls.
- Evaluated left ventricular dimensions (transverse and longitudinal axes).
- Assessed transmitral and transtricuspid flows using Doppler echocardiography.
- Recorded jugular venous pulse waveforms.
Main Results:
- Right ventricular early diastolic filling was normal in patients.
- Tricuspid ring motion during right atrial systole was exaggerated in patients (1.2 vs 0.8 cm).
- Left ventricular isovolumic relaxation time was prolonged (70 vs 55 ms), with discoordinate septal long-axis wall motion before mitral valve opening.
Conclusions:
- The Bernheim 'a' wave in LVH is not caused by right ventricular inflow obstruction.
- Increased left atrial activity may be mirrored in the right atrium via interatrial myocardial fibers.
- This phenomenon may represent a form of atrial interaction influencing the JVP.