- Distinguishing JVP from carotid
- Examination of JVP
- Exam: Kussmal's sign
- Exam: hepatojugular reflux
- Causes of elevated JVP
- Causes of abnormal waveform
- Manometer of right atrial pressure.
- Function at waveform points: ASK ME:
Maximal atrial filling
Emptying of atrium
- S1 occurs with 'a' and 'c' wave, S2 occur with 'v' wave.
- Fills from above.
- Complex, double pulsation for each arterial pulse [if pt has normal sinus rhythm].
- Usually visible, but not palpable.
- Changes with posture [decreases as sit up more vertical].
- Moves on inspiration [decreases in healthy].
- Hepatojugular reflux.
- Pt. must be at 45°. Pt's head tilted upwards and facing slightly away from Dr.
- Use the internal jugular, not external jugular. External jugular is lateral to SCM and
easier to see. Internal jugular is medial/behind the clavicular head of SCM. Distinguish from carotid pulse.
- Shine a torch [light] on internal jugular vein at an oblique angle.
- Extend torch out horizontally from highest point of JVP pulsations, use ruler to measure
vertical height from sternal notch to torch.
- Height >3cm above sternal angle is pathologic (raised ventricular filling pressure or
volume overload often from RHF). Key is 3cm and JVP has 3
- In normal person, usu. can't see the JVP when pt is at 45°, but can see when pt is
- Optionally: auscultate heart or feel carotid pulse to help identify JVP by its complex
- Place Pt. sitting up at 90°.
- JVP becomes more distended during inspiration (classically constrictive pericarditis,
currently severe RHF). This is opposite of what happens in normal pt.
- Usually negative in cardiac tamponade.
- Exert pressure on liver for 15 sec.
- Venous return to right atrium increases.
- JVP will rise transiently in normal person.
- Check if remains elevated (RVF).
Too much fluid:
- Fluid overload [esp. IV infusion]
It's clogging up before gets to heart:
Can't beat it out of the heart fast enough:
- Constrictive pericarditis
- Pericardial effusion
- Tricuspid stenosis or regurgitation
- Dominant a wave
- Cannon a wave
Complete heart block
Paroxysmal nodal tachycardia
- Dominant v wave [easily heard].
- Absent x descent
- Exaggerated x descent
- Sharp y descent
- Slow y descent
Right atrial myxoma