A V wave in the jugular venous pulse represents venous filling of the right atrium when the tricuspid valve is closed. In severe tricuspid valve regurgitation, there is dramatic accentuation of the jugular V wave (sometimes difficult to distinguish from elevated jugular venous pressure from right heart failure). Similarly, when examining a left atrial (or pulmonary capillary wedge) pressure tracing, the V wave is accentuated in severe mitral regurgitation.