What is the normal Jugular Venous Pressure (JVP)?

From the Guidelines

The normal jugular venous pressure (JVP) is less than 3-4 cm above the sternal angle when a person is positioned at a 45-degree angle. This measurement reflects the pressure in the right atrium of the heart and provides valuable information about a patient's volume status and cardiac function, as noted in the assessment and grading of congestion in acute heart failure 1. To assess JVP, examine the internal jugular vein on the right side of the neck while the patient is semi-reclined at 45 degrees. The highest point of visible or palpable pulsation is measured vertically from the sternal angle. Normal JVP will show a characteristic waveform with a, c, and v waves corresponding to atrial contraction, tricuspid valve closure, and atrial filling. An elevated JVP (above 4 cm) may indicate conditions such as heart failure, fluid overload, or tricuspid valve disease, while a low JVP might suggest hypovolemia. The JVP assessment is particularly useful because it provides a non-invasive window into right-sided cardiac pressures and helps guide clinical management of cardiovascular and volume-related conditions. Some limitations to JVP measurement include patient body habitus, such as obesity or respiratory pathology, which can affect the accuracy of the assessment 1.

Key points to consider when assessing JVP include:

• The patient's position, which should be at a 45-degree angle
• The measurement of the highest point of visible or palpable pulsation from the sternal angle
• The characteristic waveform with a, c, and v waves
• Potential limitations, such as patient body habitus, that can affect the accuracy of the assessment
• The association between JVP elevation and increased risk for heart failure hospitalization, as noted in the study by the acute heart failure committee of the heart failure association of the European Society of Cardiology 1.

In clinical practice, accurate assessment of JVP is crucial for guiding therapy and monitoring congestion in patients with heart failure, and its use as a simple measurement of congestion makes it a valuable tool in patient management 1.

From the Research

Normal JVP Characteristics

• The normal jugular venous pressure (JVP) can be predicted by observing a 50% inspiratory collapse of the inferior vena cava, as shown by echocardiography 2.
• In a clinical examination, if the jugular vein collapses during deep inspiration, it suggests a normal JVP 2.
• Visible veins that collapse during deep inspiration or with a vigorous sniff also indicate a normal JVP 2.
• The normal U-JVP is 6.35 cm, as measured by ultrasonography, which is slightly lower than the published normal E-JVP 3.

JVP Measurement Techniques

• Ultrasonography can be used to measure JVP, and the normal range is 6.35 cm, with excellent interrater reliability 3.
• A simple method to estimate JVP is to visually identify the internal jugular venous pulsation on the right side above the right clavicle in the sitting position 4.
• The correct method of evaluating JVP involves assessing the physiologic and anatomic basis for the jugular venous pressure, including the discrepancy between right atrial and central venous pressures 5.

Clinical Relevance of JVP

• JVP is an important element of the physical examination, particularly in assessing the severity and response to treatment of congestive heart failure 5.
• Elevated JVP can be a sign of cardiac tamponade, a medical emergency caused by the accumulation of pericardial fluid, blood, pus, or air in the pericardium 6.
• High JVP after exercise is associated with exercise intolerance and poor prognosis in patients with heart failure 4.