Jugular Venous Pressure

Examination Technique

  • 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.

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  • 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
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NB ‘c wave’ is almost never visible
  • 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
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