During bedside examination of the jugular venous pulse in a healthy adult, a small positive deflection is seen immediately after S1. Which event produces this 'c' wave?

• A Right atrial contraction against a closed tricuspid valve
• B Right ventricular contraction bulging the closed tricuspid valve into the right atrium ✓
• C Rapid passive filling of the right ventricle after tricuspid opening
• D Descent of the tricuspid annulus during rapid ventricular ejection

Explanation

The c wave occurs just after S1 when right ventricular systole pushes the closed tricuspid valve backward into the right atrium, transiently raising atrial pressure; transmitted carotid pulsation also contributes. Option A describes the a wave, option C describes the v wave falling as the y descent begins, and option D describes the x descent. Recognizing this timing distinguishes the c wave from both atrial and filling-related deflections.

Reference: Ganong's Review of Medical Physiology, 26th ed.

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