What can be learned from examining the jugular vein and the Jugular Venous Pressure (JVP)?

From the Guidelines

Examining the jugular vein and jugular venous pressure (JVP) provides valuable information about a patient's cardiovascular status and right heart function, allowing for the assessment of central venous pressure, right atrial pressure, and right ventricular filling pressures. When assessing the jugular vein, it is essential to position the patient between supine to sitting to visualize the top of the venous pulsation, and either the internal or external jugular vein can be used to estimate jugular venous pressure 1. The distance in centimeters for jugular pulsations above the sternal angle should be added, and the distance in centimeters for jugular pulsations below the sternal angle should be subtracted, adjusting the distance added based on the position of the patient used to visualize venous pulsation 1.

Key Findings

• Normal JVP is typically 6-8 cm H2O and should decrease with inspiration (negative Kussmaul's sign)
• Elevated JVP suggests volume overload, right heart failure, cardiac tamponade, or superior vena cava obstruction
• The waveform of the JVP contains important components: the a wave (atrial contraction), c wave (tricuspid valve closure), v wave (atrial filling), and x and y descents
• Abnormalities in these waves can indicate specific cardiac conditions, such as cannon a waves suggesting atrioventricular dissociation, while prominent v waves may indicate tricuspid regurgitation 1

Clinical Implications

• The hepatojugular reflux test, performed by applying pressure on the liver while observing the jugular vein, can help distinguish between cardiac and non-cardiac causes of elevated JVP
• The character of the jugular vein itself can reveal information about blood viscosity and vascular tone
• This simple bedside examination provides crucial hemodynamic information without invasive procedures, and is a valuable tool in the assessment of patients with cardiovascular disease 1

From the Research

Examination of the Jugular Vein and JVP

When examining the jugular vein and the jugular venous pressure (JVP), several key points can be observed, including:

• The collapse of the jugular vein during deep inspiration, which can indicate a normal right atrial pressure and JVP 2
• The visibility and collapse of the jugular vein, which can suggest a normal, elevated, or low JVP 2
• The waveform and pattern of the JVP, which can be reflective of specific conditions, such as congestive heart failure or cardiac tamponade 3, 4

Clinical Relevance

The examination of the jugular vein and JVP can provide valuable information about a patient's cardiovascular status, including:

• The severity and response to treatment of congestive heart failure 3, 5
• The presence of cardiac tamponade, which can be a medical emergency 4
• The effectiveness of treatments, such as diuretics, vasodilators, and angiotensin-converting enzyme inhibitors, in reducing symptoms and improving outcomes 5, 6

Key Findings

Some key findings that can be observed when examining the jugular vein and JVP include:

• Distended neck veins that do not collapse, which can indicate an abnormally elevated venous pressure 2
• Visible veins that collapse during deep inspiration or with a vigorous sniff, which can suggest a normal JVP 2
• Distant heart sounds, which can be a sign of cardiac tamponade 4
• Hypotension and increased jugular venous pressure, which can be indicative of cardiac tamponade or other cardiovascular conditions 4, 6