Jugular Venous Pulsation

Aka: Jugular Venous Pulsation, Jugular Venous Distention, Jugular Venous Pulse, Jugular Venous Pressure, Kussmaul's Sign, JVD, JVP, Hepatojugular Reflux, Abdominojugular Test, HJR

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II. Physiology: Atrial Pressure Waves

  1. A Wave
    1. Rise in atrial pressure during late diastole with atrial contraction
    2. A Wave may be visible at Jugular Vein in neck on bedside exam
      1. Precedes carotid pulsation
    3. Large A Wave causes
      1. Pulmonary Artery Stenosis
      2. Third degree AV Block
        1. Atrium contracts against a closed tricuspid valve (simultaneous atrial and ventricular contraction)
  2. C Wave
    1. Atrioventricular valves close during the start of systole
  3. V Wave
    1. Atrial filling during systole
    2. Large V Wave Causes
      1. Large V waves may be visible in neck (coinciding with S1 Heart Sound)
      2. Tricuspid insufficiency

III. Technique: Jugular Venous Pressure measurement

  1. Examine position
    1. Head of bed elevated at 45 degree angle
    2. Head turned to right
  2. Identify top of venous pulsation in neck (JVP)
    1. Jugular Venous Pulsations are inward
    2. Contrast with outward Carotid Artery pulsations
  3. Identify the sternal angle (Angle of Louis)
    1. Located at superior edge or notch of Sternum
  4. Measure distance between top of pulsation and Sternum
    1. Measured in centimeters

IV. Interpretation: Distance between JVP and Sternum

  1. Normal: 4 cm or less
  2. Increased >4 cm (Jugular Venous Distention)
    1. Right-sided Heart Failure (most common)
      1. Increased Right Atrial Pressure
    2. Constrictive Pericarditis
    3. Tricuspid stenosis
    4. Superior Vena Cava Obstruction
    5. Valsalva phenomenon (laughing, coughing)
  3. Provocative: Hepatojugular Reflux
    1. Apply firm pressure to midabdomen for 30 seconds
      1. Apply 20-30 mmHg of pressure
    2. Positive test: >4 cm JVP rise for >10 seconds
      1. Suggests CHF (right or left sided failure)
      2. Falsely positive if Valsalva (abdominal guarding)
  4. Kussmaul's Sign
    1. Paradoxical rise in JVP with inspiration
      1. JVP normally falls with inspiration
    2. Causes
      1. Constrictive Pericarditis
      2. Cardiac Tamponade

V. Efficacy in CHF diagnosis

  1. Jugular Venous Distention (JVD) alone
    1. Test Sensitivity: 17%
    2. Test Specificity: 98%
  2. JVD with Hepatojugular reflex (provocative)
    1. Test Sensitivity: 33%
    2. Test Specificity: 94%

VI. References

  1. Bates (1991) Physical Exam, p. 287-8
  2. Timmis (1988) Cardiology, p. 12
  3. Degowin (1987) Bedside Exam, p. 409-15
  4. Dosh (2004) Am Fam Physician 70:2145-52 [PubMed]

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Related Studies

Ontology: Hepatojugular reflux (C0239949)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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)
Derived from the NIH UMLS (Unified Medical Language System)

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