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Abnormally large A waves indicate increased resistance to right atrial emptying from right ventricular hypertrophy, as in severe pulmonary stenosis, or from tricuspid stenosis.
The A waves are easily visible in the neck. They are short and sharp, and precede the carotid pulse that is palpated on the other side of the neck.
A waves are absent in atrial fibrillation, since coordinated atrial contraction is necessary to produce them, and so are not always seen in tricuspid stenosis.