Raised Jugular Venous Pressure
Overview
- 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.
- White: clavicle
- Black: sternocleidomastoid muscle
- Blue: internal jugular vein
- Red: external carotid artery
Interpretation
- The JVP is elevated if the vertical distance between the sternal angle and the highest point of the pulse is greater than 4cm.
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
- Pulmonary hypertension
Hepatojugular Reflux
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
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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