Jugular Venous Pressure

Question 1

JVP- anatomy

Answer 1

• Jugular venous pressure and waveform
• Estimate the JVP by observing the level of pulsation in the intemal jugular vein.
• The vein runs deep to the sternomastoid muscle and enters the thorax between the sternal and cavicular heads.
• The normal JVP waveform has two main peaks per cycle, which helps to distinguish it from the carotid arterial pulse.
• Although the right internal jugular vein is traditionally used, studies using the left internal jugular vein have yielded similarly accurate results.
• The external jugular vein is more superficial, prominent and easier to see.
• It can be kinked or obstructed as it traverses the deep fascia of the neck but, when visible and pulsatile, can be used to estimate the JVP in difficult cases.
• The JVP level reflects right atrial pressure (normailly<7 mmHg/9-10 cmH2O).
• If right atrial pressure is low, the patient may have to lie flat for the JVP to be seen:if high, the patient may need to sit upright(Fig.4.14).

Question 2

JVP Exam

Answer 2

• put pt at 45’ angle and head behind a pillow
• look across the patients neck from right to left
• identify the JV pulsation behind the sternicleidomastoid (usually just above the clavicle)
• if a pulsation is visualised, use the abdominojugular/occlusion test to confirm JVP
• JVP is the vertical height in cm between the upper limit of the venous pulsation and the sternal angle
• identify the timing and waveform of the pulsation and note any abnormality

Question 3

JVP Exam if it is difficult to tell waveform from arterial pulsation

Answer 3

• abdominojugular test: press firmly on abdomen
• changes with respiration: JVP falls with inspiration (increased intrathoracic pressure)
• occlusion: the JVP waveform is obilterated by gently occluding the vein at the base of the neck
• JVP varies with position

Question 4

JVP Waveforms

Answer 4

• a wave corresponds to right atrial contraction and occurs just before the first heart sound.
• in AF a wave is absent
• v wave is caused by atrial filling during ventricular systole when the tricuspid valve is closed
• rarely, a third peak (c wave) may be seen due to closure of the tricuspid valve

Question 5

JVP meaning

Answer 5

• Better to estimate high, medium, low
• > 3cm suggests elevated central venous pressure which occurs when fluid overloaded (especially HF)
• also any condition that leads to high right ventricular filling pressure- PE, pulmonary HTN, cardiac tamponade or pericardial constriction
• dyspnoea and elevated JVP is a very valuable sign in diagnosing HF. Examine for oedema/effusions/ascities
• if raised due to obstruction of vena cava (lung Ca) abdo test will be negative
• kussmauls sign is a paradoxical rise of JVP on inspiration that is seen in pericardial constriction, severe RV failure and restrictive cardiomyopathy

Question 6

Precordium

Answer 6

• ## The precordium is the anterior chest surface overlaying the heart