Notch in TR Jet in Complete Heart Block and Junctional Rhythm

Tricuspid regurgitation jet in complete heart block and junctional rhythm

Tricuspid regurgitation jet can show a notch during atrial systole when the P waves occur during systole. This can be seen as a regular feature in all cycles in junctional rhythm while it is varying in complete heart block. The notch may be visible only if the tricuspid regurgitation jet envelope is complete and the right ventricular pressures normal as in non-hypertensive tricuspid regurgitation.