Giant V wave on examination of the jugular venous pulse is suggestive of

(B) tricuspid incompetence # Tricuspid regurgitation causes the v wave to be more prominent; when tricuspid regurgitation becomes severe, the combination of a prominent v wave and obliteration of the x descent results in a single large positive systolic wave.> After the v wave peaks, the right atrial pressure falls because of the decreased bulging of the tricuspid valve into the right atrium as right ventricular pressure declines and tricuspid valve opens# Jugular venous pulse> Normal: 3 +ve pulse waves -a, c and v 2 -ve pulse waves -x and y> 'a'wave: Due to right atrial contraction Synchronous with carotid artery pulse> Absent'a'wave : Atrial fibrillation> Diminished 'a' wave: Tachycardia Prolonged PR interval> 'a' Wave Fused with (c' Wave: Supra ventricular tachycardia> Large 'a' Waves : Pulmonary hypertension Pulmonary stenosis Tricuspid stenosis Tricuspid atresia AV dissociation> Cannon Waves (Giant 'a' Waves) : Complete heart block when right atrium occasionally contracts against closed tricuspid valve Ventricular tachycardia Ectopic beats> Regular 'a' Waves : AV junctional rhythm 10AV block 2 : 1 AV block Atrial tachycardia> Irregular 'a' Waves: Premature systoles: Atrial Ventricular AV junctional Complete AV dissociation: Complete AV block AV junctional tachycardia Ventricular tachycardia Atrial flutter> Non-conducted 'a' waves: Atrial tachycardia Atrial flutter with block> 'c' Wave : Produced by Impact of carotid artery to jugular vein Retrograde transmission of positive wave in right atrium (by ventricular systole and bulging of tricuspid valve into right atrium). Carotid artefact Systolic bulging of tricuspid valve into RA> V Wave: Absent 'x' wave: Constrictive pericarditis Restrictive cardiomyopathy ASD (sometimes)> v Wave : during ventricle contraction caused by atrial filling and occurs with and just after carotid pulse.# Large V Waves: Tricuspid regurgitation ASD Anomalous pulmonary venous drainage, Right sided heart failure> 'y' Wave: Slow Descent y Wave : Tricuspid stenosis Sharp Descent y Wave : Constrictive pericarditis Rapid Descent y wave : Constrictive pericarditis (Friedreich's sign) Severe heart failure Tricuspid regurgitation