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Raised Jugular Venous Pressure



  • 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

    • 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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