- Get the patient to relax. Make sure not to use too many pillows (best seen with the head lying directly against the bed)
- With the patient lying at around 45°, ask the patient to gently turn their head to the left. The JVP may be seen rising from the clavicle, between the heads of the sternocleidomastoid muscle.
- To differentiate between pulsations from the carotid pulse-
- JVP will sink into the clavicle as you raise the bed, or with patient inspiration
- JVP is not palpable
- JVP usually has a bifid waveform (see below)
- JVP will usually rise in response to ‘hepatojugular reflex’
- deep pressure is applied to the RUQ (better during expiration)
- Measure the JVP as the vertical height from the sternal angle to the top of the JVP
- Usually < 3cm
- In AF there is no effective atrial contraction and so no ‘a wave’.
- In Tricuspid regurgitation, there are ‘systolic cv waves’ (prominent v waves) due to the right ventricular impulse being transmitted through the incompetent tricuspid valve during systole.
- In pulmonary hypertension (e.g. in pulmonary embolic disease); the JVP will be elevated with large ‘a waves’ as the right atrium tries to overcome the high pressures
- In complete heart block, the atria and ventricles contract out of synchrony. Occasionally, atrial systole will occur just before ventricular systole and cause an extra large ‘cannon a wave’ as the right atrium contracts against a closed tricuspid valve. (Can also occur in tricuspid stenosis)
- Things that don’t effect JVP:
- Mitral regurgitation; small VSDs
- Kussmaul’s sign is a JVP that rises (paradoxically- usually shortens) with inspiration. May be caused by conditions which restrict the heart e.g. pericardial effusion/tamponade; contrictive pericarditis ; restrictive cardiomyopathy; as well as right heart failure