What causes a prominent a wave in jugular venous pulse?

What causes a prominent a wave in jugular venous pulse?

Prominent a wave occurs when the right atrial contraction is more forceful due to increased resistance to right atrial emptying. This occurs in right ventricular hypertrophy, pulmonary hypertension, and tricuspid stenosis. In pulmonary stenosis with right ventricular hypertrophy, prominent a wave would suggest intact interventricular septum. Prominent a wave will be absent in the presence of associated unrestrictive ventricular septal defect. This is because an unrestrictive VSD prevents right ventricular pressure from rising to suprasystemic levels. Prominent a wave can be associated with a presystolic hepatic pulsation.