Elevated Jugular Venous Pressure (JVP)

Definition:

High blood the pressure in the venous system as blood returns to the right side of the heart before it is sent into the pulmonary circulation.

Causes:

Congestive heart failure, Superior vena cava obstruction (the veins do no pulsate), Hypervolemia (fluid overload), Pulmonary embolism and Cardiac tamponade.

Examination:

The patient lies supine and at 45 degrees. The internal jugular vein is visualised as it ascends the side of the neck between the two heads of the sternocleidomastoid muscle. The internal JVP is normally located with a visible double pulsation close to the clavicle bone in the triangle shape formed by the sternal and clavicular head of the sternocleidomastoid muscle when the neck is rotated to the left. If the jugular vein appears to be distended attempt to measure the height of the distension as a vertical column of blood in relation to the sternal angle. Measure the level of the internal JVP by measuring the vertical distance between the sternal angle and the top of the JVP double pulsation. A normal jugular venous pressure should not exceed 3-4 cm above the sternal angle. Do not mistake the external jugular for the internal (our target is the internal jugular in this exam).

Tip: Differentiate Internal Jugular vs. Carotid

  1. The JVP has a biphasic movement on visual inspection while the carotid is monophasic
  2. The JVP is not palpable where as the carotid is palpable.
  3. The JVP changes (moves) with a change in the angle of the bed.