Jugular contour recognition by naming and timing descents.

Jugular wave recognition requires looking for descents rather than rises. The dominant normal descent is systolic and should be called the X prime (X') descent. The X' is a rapid collapse caused by the descent of the base of the right ventricle and can be easily recognized by noting that the collapse falls onto the second heart sound or is simultaneous with the radial pulse. The V wave and Y descent is expected to be easily visible only in the young. The C wave is never visible. It is difficult to learn jugular recognition from most textbooks mainly because they use the letter X for both the atrial relaxation descent and the descent of the base descent and also, they teach from artifactual pulse tracings and they recommend looking for waves rather than descents.