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Renal Exam

Jugular Venous Pressure

November 28th, 2019


The jugular venous pulsation can often be difficult to visualise, though can be a useful indicator of the fluid status of a patient. The JVP can also provide valuable clues regarding the presence of right ventricular failure, pulmonary hypertension and tricuspid regurgitation.
  • Look For

  • The pulsation of the jugular vein, between the sternal and clavicular heads of the sternocleidomastoid.
Position the patient at 45 degrees and ask them to turn their head to the left. Hold a flashlight tangentially to the skin of the neck and inspect for the highest level of the jugular venous pulsation. Measure the vertical distance between the sternal angle and this level.
  • Interpretation

  • The JVP is elevated if the vertical distance between the sternal angle and the highest point of the pulse is greater than 4cm.
  • Significance

  • Elevated JVP is indicative of increased right ventricular filling pressure.
  • Causes of Elevated JVP

  • Fluid overload - excessive IV fluids, renal disease, heart failure
  • Right ventricular systolic failure - cor pulmonale, left ventricular failure
  • Right ventricular diastolic failure - constrictive pericarditis, tamponade

Hepatojugular Reflex

  • How to Elicit

  • Gently press over the right upper quadrant for 10-15 seconds while inspecting the JVP.
  • Significance

  • The reflex temporarily increases venous return to the right atrium, making the jugular venous pulsation more pronounced.

Structure of the JVP

  • Structure of the JVP
  • Significance

  • A wave - right atrial contraction
  • C wave - early ventricular contraction
  • X descent - downward movement of the ventricle during systolic contraction
  • V wave - filling of right atrium
  • Y descent - opening of tricuspid valve in diastole
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