Figure 32-26 Central venous pressure (CVP) changes in tricuspid valve disease. A, Tricuspid regurgitation increases mean CVP, and the waveform displays a tall systolic c-v wave that obliterates the x descent. In this example, the a wave is not seen because of atrial fibrillation. Right ventricular end-diastolic pressure is estimated best at the time of the electrocardiographic R wave (arrows) and is lower than mean CVP. B, Tricuspid stenosis increases mean CVP, the diastolic y descent is attenuated, and the end-diastolic a wave is prominent. (Redrawn from Mark JB: Atlas of Cardiovascular Monitoring. New York, Churchill Livingstone, 1998, Figs. 17-3 and 17-15.)