What is a normal Jugular Venous Pressure (JVP)?

From the Guidelines

Normal jugular venous pressure (JVP) is typically measured by assessing the distance of jugular pulsations above the sternal angle, with the patient positioned between supine to sitting, and is usually estimated to be around 6-8 cm of water 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 serves as an important clinical indicator of cardiovascular function 1. When assessing JVP, healthcare providers look for the highest point of pulsation in the internal jugular vein, which is most visible in the neck when the patient is properly positioned.

• Key points to consider when measuring JVP include:
  • Positioning the patient between supine to sitting to visualize the top of the venous pulsation 1
  • Using either the internal or external jugular vein to estimate jugular venous pressure 1
  • Adjusting the distance added based on the position of the patient used to visualize venous pulsation 1
  • Decrease with inspiration (negative Kussmaul's sign) and increase with expiration
• The JVP waveform consists of several components including the a, c, and v waves, which correspond to atrial contraction, tricuspid valve closure, and atrial filling respectively.
• Elevated JVP (above 8 cm) may indicate right-sided heart failure, fluid overload, or cardiac tamponade, while decreased JVP might suggest hypovolemia, as noted in studies on heart failure management 1.
• Accurate assessment of JVP requires proper patient positioning, adequate lighting, and careful observation of the pulsations in the neck to distinguish venous from arterial pulsations.

From the Research

Normal JVP Characteristics

• A normal jugular venous pressure (JVP) can be indicated by the collapse of the jugular vein during deep inspiration, as proposed by 2.
• In the supine position, visible veins that collapse during deep inspiration or with a vigorous sniff suggest a normal JVP 2.
• The normal U-JVP is 6.35 cm, as determined by ultrasonography, which is slightly lower than the published normal E-JVP 3.
• The top of the internal jugular vein column is located less than 25% of the distance from the clavicle to the angle of the jaw in the majority of healthy adults 3.

Assessment Methods

• Ultrasonography can be used to measure JVP, providing a more reliable and accurate assessment compared to traditional physical examination methods 3, 4.
• Point-of-care ultrasonography assessment of the JVP is feasible, reproducible, and accurately predictive of elevated central venous pressures in patients undergoing right heart catheterization 4.
• A simple method of estimating JVP by visually identifying the internal jugular venous pulsation on the right side above the right clavicle in the sitting position can be used to assess JVP in patients with heart failure 5.

Clinical Relevance

• Assessment of JVP is important in evaluating the severity and response to treatment of congestive heart failure 6.
• Elevated JVP after exercise is associated with exercise intolerance and poor prognosis in patients with heart failure 5.
• The response of JVP to exercise may be a new approach for risk assessment in patients with heart failure 5.