Examination of the jugular venous pulse
- Theo E Meyer, MD, PhD
Theo E Meyer, MD, PhD
- Professor of Medicine
- Chief, Clinical Cardiology
- Director, Advanced Heart Failure Program
- University of Massachusetts Medical School
- UMassMemorial Medical Center
The careful examination of jugular venous wave forms in the neck provides the clinician with a reliable estimate of central venous pressures (CVP), and it also imparts prognostic information in patients with heart failure . Concern has been raised that clinicians have become less attentive to the bedside evaluation of physical signs as technology for diagnostic testing has advanced . Yet, the bedside evaluation of CVPs remains nearly universally feasible, clinically meaningful, immediately available, and readily repeatable.
This topic will discuss the examination of the jugular venous pulse. Other components of the cardiovascular examination including inspection of precordial pulsation, examination of the arterial pulse, auscultation of heart sounds, and auscultation of cardiac murmurs are discussed separately. (See "Examination of the precordial pulsation" and "Examination of the arterial pulse" and "Auscultation of heart sounds" and "Auscultation of cardiac murmurs in adults" and "Physiologic and pharmacologic maneuvers in the differential diagnosis of heart murmurs and sounds" and "Overview of common causes of cardiac murmurs in infants and children" and "Approach to the infant or child with a cardiac murmur".)
Inspection of the jugular veins enables visible evaluation of central venous pressures which reflect volume in the central venous reservoir.
The central veins are thin walled, distensible reservoirs and conduits of blood in continuity with the right atrium. The volume in this venous reservoir is determined by the inflow from venous return from the upper and lower parts of the body and the outflow through the right atrium to the right ventricle.
The visual appreciation of the extent of jugular venous distention and the characteristics of the pressure waves are dependent on clear understanding and appreciation of the anatomic relations of the vein to fixed anatomic structures in the neck (figure 1). The internal jugular vein (IJV) is formed by the joining of the inferior petrosal sinus and the sigmoid sinus at the base of the brain and exits the skull via the jugular foramen. The IJV then descends vertically within the carotid sheath, lateral to the internal carotid artery and common carotid artery and deep to the sternocleidomastoid. The IJV joins the subclavian vein to form the brachiocephalic vein at the base of the neck (figure 1).
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- ANATOMIC CONSIDERATIONS
- Evidence on utility and limitations
- - To estimate right atrial pressure
- - To identify and assess heart failure
- - To assess risk of progression of ALVSD to heart failure
- - To assess prognosis in patients with heart failure
- HOW TO EXAMINE THE JUGULAR VENOUS PULSE
- Approach to examination
- Which jugular vein to examine
- - General approach
- - Additional considerations for the EJV
- - Distinguishing venous and arterial pulsations
- - Venous pulse not identified
- Estimating right atrial pressure
- - General principles
- - Causes of elevated jugular venous pressure
- - Positional changes
- - Respirophasic changes
- - Abdominojugular test
- SUMMARY AND RECOMMENDATIONS