{"id":1684,"date":"2020-05-18T10:07:25","date_gmt":"2020-05-18T17:07:25","guid":{"rendered":"https:\/\/up.physicaldiagnosispdx.com\/up\/?page_id=1684"},"modified":"2021-05-07T08:53:26","modified_gmt":"2021-05-07T15:53:26","slug":"lancisis-sign-cv-fusion-2","status":"publish","type":"page","link":"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-multimedia-new\/lancisis-sign-cv-fusion-2\/","title":{"rendered":"Lancisi&#8217;s Sign"},"content":{"rendered":"<div class=\"wpb-content-wrapper\">[vc_row css=&#8221;.vc_custom_1592016498997{background-color: #fff9f9 !important;}&#8221;][vc_column][vc_column_text]<span style=\"font-size: 14pt;\">In the setting of severe tricuspid regurgitation, retrograde blood flow into the right atrium during ventricular systole results in loss of the x descent, creating a fused cv wave that appears as a large pulsation within the internal jugular vein. This wave is typically followed by an augmented y descent, which is the consequence of an increased pressure gradient between the right atrium and right ventricle. The often palpable cv fusion wave is one of the exceptions to the rule that the jugular venous waveform is nonpalpable. Listen for an associated holosystolic murmur over the left lower sternal border that augments with inspiration.<\/span><\/p>\n<p><a href=\"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-2\/card-tutorial\/#Lancisis_Sign\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-1658 size-thumbnail\" src=\"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308-150x150.png\" alt=\"\" width=\"150\" height=\"150\" srcset=\"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308-150x150.png 150w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308-300x300.png 300w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308.png 512w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 1:<\/h1>\n<p><span style=\"font-size: 14pt;\">This patient has severe tricuspid regurgitation. These videos demonstrate a jugular venous waveform with CV fusion (Lancisi\u2019s sign). Note that the large outward wave is followed by only one descent (the y descent), distinguishing it from giant a waves, in which there are two descents that follows (x and y). When auscultating the heart of a patient with Lancisi\u2019s sign, listen for a holosystolic murmur that augments with inspiration at the left lower sternal border.\u00a0<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592016519881{background-color: #dcd9dd !important;}&#8221;][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472337806?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&amp;amp;lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&amp;amp;gt;\ufeff&amp;amp;lt;\/span&amp;amp;gt;<\/iframe><\/p>\n[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/546140867?loop?1\" width=\"640\" height=\"320\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 2:<\/h1>\n<p><span style=\"font-size: 14pt;\">This patient developed severe tricuspid regurgitation as a result of dilated cardiomyopathy and pulmonary hypertension.<\/span> <span style=\"font-size: 14pt;\">These videos demonstrate a jugular venous waveform with CV fusion (Lancisi&#8217;s sign). Notice involvement of the facial vein that crosses over the jawline.\u00a0<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592016542067{background-color: #dcd9dd !important;}&#8221;][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><strong><span style=\"font-size: 18pt;\">Lancisi&#8217;s Sign<\/span><\/strong><br \/>\n<iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472316261?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&amp;amp;lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&amp;amp;gt;\ufeff&amp;amp;lt;\/span&amp;amp;gt;<\/iframe>[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><strong><span style=\"font-size: 18pt;\">Annotated<\/span><\/strong><br \/>\n<iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472316453?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&amp;amp;lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&amp;amp;gt;\ufeff&amp;amp;lt;\/span&amp;amp;gt;<\/iframe>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 3:<\/h1>\n<p><span style=\"font-size: 14pt;\">This patient developed severe tricuspid regurgitation after injury to the valve during a right heart catheterization procedure.\u00a0These videos demonstrate a jugular venous waveform with CV fusion waves (Lancisi&#8217;s sign). Note the impressive y descent, which is augmented as a result of the increased pressure gradient between the right atrium and right ventricle generated by retrograde blood flow into the right atrium during ventricular systole.\u00a0<\/span><\/p>\n<p><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMicm1502066\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-size: 14pt;\">Video courtesy of NEJM: &#8220;Lancisi&#8217;s sign&#8221;<\/span><\/a>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592016558749{background-color: #dcd9dd !important;}&#8221;][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><strong><span style=\"font-size: 18pt;\">Lancisi&#8217;s Sign<\/span><\/strong><br \/>\n<iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472316769?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&amp;amp;lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&amp;amp;gt;\ufeff&amp;amp;lt;\/span&amp;amp;gt;<\/iframe>[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><strong><span style=\"font-size: 18pt;\">Annotated<\/span><\/strong><br \/>\n<iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472316748?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&amp;amp;lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&amp;amp;gt;\ufeff&amp;amp;lt;\/span&amp;amp;gt;<\/iframe>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1 id=\"patient4\">Patient 4:<\/h1>\n<p><span style=\"font-size: 14pt;\">This patient has severe tricuspid regurgitation. <\/span><\/p>\n<p><span style=\"font-size: 14pt;\">This patient also has a <\/span><a href=\"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-2\/cardiology-multimedia-new\/5865-2\/#patient1\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-size: 14pt;\">lateral (side-to-side) head bob.<\/span><\/a>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472337338?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&amp;amp;lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&amp;amp;gt;\ufeff&amp;amp;lt;\/span&amp;amp;gt;<\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1 id=\"patient5\">Patient 5:<\/h1>\n<p><span style=\"font-size: 14pt;\">This patient has severe tricuspid regurgitation. <\/span><\/p>\n<p><span style=\"font-size: 14pt;\">This patient also has <\/span><a href=\"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-2\/cardiology-multimedia-new\/tricuspid-regurgitation\/#patient2\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-size: 14pt;\">tricuspid valve prolapse with a late systolic &#8220;honk&#8221; murmur over the left lateral sternal border.<\/span><\/a>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472337663?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&amp;amp;lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&amp;amp;gt;\ufeff&amp;amp;lt;\/span&amp;amp;gt;<\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 6:<\/h1>\n<p><span style=\"font-size: 14pt;\">This patient developed severe tricuspid regurgitation as a result of dilated cardiomyopathy and pulmonary hypertension.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><strong><span style=\"font-size: 18pt;\">Lancisi&#8217;s Sign<\/span><\/strong><br \/>\n<iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472315990?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe>[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><strong><span style=\"font-size: 18pt;\">Annotated<\/span><\/strong><br \/>\n<iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472315845?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&amp;amp;lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&amp;amp;gt;\ufeff&amp;amp;lt;\/span&amp;amp;gt;<\/iframe>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 7:<\/h1>\n<p><span style=\"font-size: 14pt;\">This patient has severe tricuspid regurgitation.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472338087?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&amp;amp;lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&amp;amp;gt;\ufeff&amp;amp;lt;\/span&amp;amp;gt;<\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 8:<\/h1>\n<p><span style=\"font-size: 14pt;\">This is a middle-aged woman with severe tricuspid regurgitation.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472326696?loop=1\" width=\"640\" height=\"352\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1 id=\"patient9\">Patient 9:<\/h1>\n<p><span style=\"font-size: 14pt;\">This is a middle-aged woman with severe tricuspid regurgitation from dilated cardiomyopathy (thought to be related to thyrotoxicosis).<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592017173859{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/542471426?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" data-mce-type=\"bookmark\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row]\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row css=&#8221;.vc_custom_1592016498997{background-color: #fff9f9 !important;}&#8221;][vc_column][vc_column_text]In the setting of severe tricuspid regurgitation, retrograde blood flow into the right atrium during ventricular systole results in loss of the x descent, creating a fused cv wave that appears as a large pulsation within the internal jugular vein. This wave is typically followed by an<\/p>\n","protected":false},"author":9,"featured_media":0,"parent":3164,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"page-templates\/page_PDXPDX-full-width.php","meta":{"nf_dc_page":"","_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"class_list":["post-1684","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/1684","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/comments?post=1684"}],"version-history":[{"count":6,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/1684\/revisions"}],"predecessor-version":[{"id":10584,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/1684\/revisions\/10584"}],"up":[{"embeddable":true,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/3164"}],"wp:attachment":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/media?parent=1684"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}