Pulsations of the peripheral veins have so far been known to be synonymous with tricuspid insufficiency (TI). Three patients who had using heroin intravenously for 3 to 25 years and had no evidence of TI were found to have pulsations of the veins of the upper extremities. Recording of intravenous pressure of the peripheral vein and jugular venous pulse (JVP) showed that both were identical in their wave contour and timing and showed indirectly that right atrial pressure waves were being transmitted to the veins of the arm. It is proposed that the venous valvular insufficiency produced by thrombophlebitis of the arm veins in heroin addicts and chronically elevated right atrial pressure in the patient with primary myocardial disease, was the primary cause of retrograde transmission of the right atrial pressure. The presence of normal "a" and "c" wave with good "x" descent and "v" with a normal "Y" descent rules out significant TI while a Prominent "v" wave preceded by a truncated "x" descent or regurgitant wave and followed by a sharp "Y" descent are characteristic of TI.