II. Physiology: Atrial Pressure Waves
- A Wave
- Rise in atrial pressure during late diastole with atrial contraction
- A Wave may be visible at Jugular Vein in neck on bedside exam
- Precedes carotid pulsation
- Large A Wave causes
- Pulmonary Artery Stenosis
- Third degree AV Block
- Atrium contracts against a closed tricuspid valve (simultaneous atrial and ventricular contraction)
- C Wave
- Atrioventricular valves close during the start of systole
- V Wave
- Atrial filling during systole
- Large V Wave Causes
- Large V waves may be visible in neck (coinciding with S1 Heart Sound)
- Tricuspid insufficiency
III. Technique: Jugular Venous Pressure measurement
- Examine position
- Head of bed elevated at 45 degree angle
- Head turned to right
- Identify top of venous pulsation in neck (JVP)
- Jugular Venous Pulsations are inward
- Contrast with outward Carotid Artery pulsations
- Identify the sternal angle (Angle of Louis)
- Located at superior edge or notch of Sternum
- Measure distance between top of pulsation and Sternum
- Measured in centimeters
IV. Interpretation: Distance between JVP and Sternum
- Normal: 4 cm or less
- Increased >4 cm (Jugular Venous Distention)
- Right-sided Heart Failure (most common)
- Increased Right Atrial Pressure
- Constrictive Pericarditis
- Tricuspid stenosis
- Superior Vena Cava Obstruction
- Valsalva phenomenon (laughing, coughing)
- Right-sided Heart Failure (most common)
- Provocative: Hepatojugular Reflux
- Apply firm pressure to midabdomen for 30 seconds
- Apply 20-30 mmHg of pressure
- Positive test: >4 cm JVP rise for >10 seconds
- Suggests CHF (right or left sided failure)
- Falsely positive if Valsalva (abdominal guarding)
- Apply firm pressure to midabdomen for 30 seconds
- Kussmaul's Sign
- Paradoxical rise in JVP with inspiration
- JVP normally falls with inspiration
- Causes
- Constrictive Pericarditis
- Cardiac Tamponade
- Paradoxical rise in JVP with inspiration
V. Efficacy in CHF diagnosis
- Jugular Venous Distention (JVD) alone
- Test Sensitivity: 17%
- Test Specificity: 98%
- JVD with Hepatojugular reflex (provocative)
- Test Sensitivity: 33%
- Test Specificity: 94%
VI. References
- Bates (1991) Physical Exam, p. 287-8
- Timmis (1988) Cardiology, p. 12
- Degowin (1987) Bedside Exam, p. 409-15
- Dosh (2004) Am Fam Physician 70:2145-52 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Finding (T033) |
| SnomedCT | 72196001 |
| Italian | Reflusso epatogiugulare |
| Japanese | 肝頚静脈逆流, ｶﾝｹｲｼﾞｮｳﾐｬｸｷﾞｬｸﾘｭｳ |
| Czech | Hepatojugulární reflux |
| English | hepatojugular reflux, hjr, Hepatojugular reflux, Hepatojugular reflux (finding) |
| Hungarian | Hepatojugularis reflux |
| Spanish | reflujo hepatoyugular (hallazgo), reflujo hepatoyugular, Reflujo hepatoyugular |
| Portuguese | Refluxo hepatojugular |
| Dutch | hepatojugulaire reflux |
| French | Reflux hépatojugulaire |
| German | Hepatojugulaerer Reflux |
Ontology: Paradoxical inspiratory filling of neck veins (C0240101)
| Concepts | Sign or Symptom (T184) |
| SnomedCT | 34987005 |
| English | Kussmaul's sign, Paradox insp filling neck vein, kussmauls signs, kussmaul sign, kussmaul's sign, Paradoxical inspiratory filling of neck veins, Paradoxical inspiratory filling of neck veins (finding) |
| Spanish | signo de Kussmaul (hallazgo), signo de Kussmaul |
Ontology: Jugular venous engorgement (C0425687)
| Concepts | Finding (T033) |
| SnomedCT | 271653008 |
| English | Jugular venous distension, jugular venous distention, jvd, Jugular vein distended, Jugular venous engorgement, Venous congestion of neck, Jugular venous engorgement (finding) |
| Spanish | ingurgitación venosa yugular (hallazgo), ingurgitación venosa yugular |
Ontology: Jugular venous pressure (C0428897)
| Concepts | Finding (T033) |
| SnomedCT | 37476000 |
| Italian | Pressione venosa giugulare |
| Dutch | jugulaire veneuze druk, veneuze druk jugulair |
| German | Halsvenendruck, Jugularvenendruck |
| Portuguese | Pressão da veia jugular, Pressão na veia jugular |
| Japanese | 頚静脈圧, ｹｲｼﾞｮｳﾐｬｸｱﾂ |
| English | JVP, jugular venous pressure, jugular venous pressure (physical finding), Venous pressure jugular, jugular pressure venous, venous jugular pressure, JVP - Jugular venous pressure, Jugular venous pressure, Jugular venous pressure (observable entity) |
| Czech | Venózní tlak jugulární |
| Hungarian | Jugularis vénás nyomás |
| Spanish | presión venosa yugular (entidad observable), presión venosa yugular, Presión venosa yugular |
| French | Pression veineuse jugulaire |
Ontology: Jugular venous pulse characteristics - finding (C1287739)
| Concepts | Finding (T033) |
| SnomedCT | 366212008 |
| English | Finding of jugular venous pulse characteristics, Finding of jugular venous pulse characteristics (finding), Jugular venous pulse characteristics - finding |
| Spanish | hallazgo relacionado con características del pulso venoso yugular, hallazgo relacionado con características del pulso venoso yugular (hallazgo), características del pulso venoso yugular - hallazgo, características del pulso venoso yugular - hallazgo (hallazgo) |
