Jugular Venous Pressure (JVP)

Jugular Venous Pressure (JVP)

General

  • Wash your hands upon entering the room
  • Introduce yourself and the exam to the patient in a way that the patient will understand
  • The patient should be supine with the bed angled at 30-45 degrees
  • Ask the patient to turn their head to the left
  • Drape the patient so the two heads of the right sternocleidomastoid muscle can be seen

Vital Signs

Vital signs should be measured on every patient. They include:

  • Blood pressure
  • Heart rate
  • Respiratory rate
  • Temperature
  • Oxygen saturation may also be included

Finding and Measuring the JVP

  • Ask the patient to turn their head to the left
  • Inspect for a pulsation between the two heads of the sternocleidomastoid muscle
    • This is often best seen from the foot of the bed
    • Tangential lighting may also help to appreciate the JVP
  • Once found, measure the JVP using the following method:
    • Find the sternal angle
    • Measure the verticle height of the JVP above the sternal angle using two rulers (See figure 1)
      • Normal = 2-4cm
      • Abnormal = >4cm

Figure 1: Measuring the JVP

Figure 1: Measuring the JVP

  • If you are unable to appreciate the JVP:
    • Lower the head of the bed
    • Apply tangential lighting

Distinguishing the JVP from the Carotid Pulse

The JVP has the following characteristics which distinguish it from the carotid pulse:

  1. A double waveform
  2. Is occludable
  3. Is non-palpable
  4. Changes with respiration (decreases on inspiration, increases on expiration)
  5. Changes with the angle of the bed (increases on lowering the bed, decreases on raising the bed)

Special Tests

The only special test for the JVP is the Hepatojugular Reflex

  • Apply pressure (~25mm Hg) to the patient's right upper quadrant and observe the JVP
    • Normal = Transient increase or no change┬áin the JVP
    • Abnormal = Sustained increase┬áin the JVP

Interpreting the JVP

  • Causes of a raised JVP (>4cm)
    • Obstruction in the superior vena cava (ex. caused by a pneumothorax)
    • Right heart failure
    • Constrictive pericarditis
    • Pericardial tamponade
  • Kussmaul's Sign
    • A positive sign is when the JVP paradoxically rises on inspiration
    • Caused by:
      • Constrictive pericarditis
      • Restrictive cardiomyopathy
      • Pericardial effusion
      • Severe right heart failure