Exam

Jugular Venous Distention

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

  • 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
  • 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
  • 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%
  • 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]