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Examination of the jugular venous pulse

Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Section Editor
Catherine M Otto, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Analysis of the jugular venous pressure and pulse provides information regarding hemodynamic changes in the right side of the heart.


The right internal jugular venous pulse is generally preferred for assessing right heart hemodynamics since the right internal jugular vein is in a direct line with the superior vena cava. On the other hand, the external jugular veins are more easily assessed than the internal jugular veins and can provide accurate results. We suggest examination of the right external jugular vein when the right internal jugular vein cannot be adequately visualized. (See 'External jugular vein' below.)

It is generally preferable to examine the internal rather than external jugular veins since the internal jugular veins are in a direct line with the superior vena cava and right atrium, whereas the external jugular veins are not in a direct line with the superior vena cava and connect with it after negotiating two almost 90 degree angles [1]. There are valves between the superior vena cava and both internal and external jugular veins; however, elevated venous pressure can be transmitted through the venous valves. The external jugular venous bulb is a site for thrombus formation, which can cause partial obstruction of the external jugular veins.

Partial compression of the left innominate vein is usually relieved during modest inspiration as the diaphragm and the aorta descend and the pressure in the two internal jugular veins becomes equal. However, partial obstruction of the left innominate vein from compression by the aorta may persist, particularly in relatively elderly patients, impairing transmission of right atrial pressure to the left internal jugular vein; this is also the most common cause of unequal pressures between right and left internal jugular veins. There is better transmission of right atrial pressures and pulses to the right internal jugular vein since the right innominate and internal jugular veins are in a direct line with the superior vena cava. Thus, examination of the right internal jugular venous pulse is preferable for assessing the hemodynamic changes in the right side of the heart. (See "Cardiac catheterization techniques: Normal hemodynamics".)


The normal jugular venous pulse wave or right atrial pressure wave recordings usually consist of three positive waves, a, c and v, and two negative waves, x and y [2] (figure 1). (See "Cardiac catheterization techniques: Normal hemodynamics" and "Pulmonary artery catheterization: Interpretation of hemodynamic values and waveforms in adults".)


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Literature review current through: Jul 2017. | This topic last updated: Feb 29, 2016.
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