Constrictive Pericarditis: Venous waveform

Stoelting’s Anesthesia and Co-existing Disease 5/e says: “A prominent y-descent of the jugular venous pressure (Friedreich’s sign) reflects the predominance of right ventricular filling in early diastole that is seen with constrictive pericarditis.” The pressure tracing during diastole of the RV, LV, and RA will equalize. See Figure 7-3 B for the CVP tracing during constrictive pericarditis.

(similar to restrictive cardiomyopathy or RV infarct)

Elevated mean (CVP) pressure, prominent a and v waves, steep x and y descents. Restriction from tight pericardium limits cardiac filling, decreased end-diastolic volume, stroke volume and cardiac output.