Jugular Venous Pressure (JVP)

Make the patient semi-recumbent to begin (20 – 40°)

  • Chin up and head turned slightly to the left
  • Tangential lighting
  • JVP useless as a marker of CVP in tricuspid regurgitation

Find the pulse!

  • Seen low between the two heads of the SCM
  • Palpate the carotid and compare the impulse you see to that which you feel

JVP vs Carotid pulse

  • Complex JVP waveform (biphasic)
  • JVP increases with expiration and drop with inspiration.
  • JVP will change in the angle of the bed
  • JVP can be occluded, the carotid cannot
  • JVP does not have a pulse (unless flail tricuspid and pulmonary hypertension)
  • Hepatojugular reflex
    • 30 mm Hg pressure on the liver
    • + → sustained rise of ≥ 3 cm x ≥ 10 s or 3 respiratory cycles
    • After 3 respiratory cycles (10s) it should return to normal
    • Suggests RCHF, constrictive pericarditis, pericardial tamponade, TR



 

Describe the JVP: what wave is dominant?

  • Discriminate with concomitant attention to the contralateral carotid pulse
  • A-wave – Atrial contraction before S1
    • Cannon A wave: atrial contraction against severe TS
    • Prominent: TS, RVH, PULM HTN, PS
    • Absent: AFIB
  • X-descent – Atrium relaxes
  • C-wave – Tricuspid closure and retrograde bulging
  • V-wave – Filling of atrium prior to TV opening
    • Prominent CV wave → TR
  • Y-descent – Ventricular filling

Special test

  • Kussmaul Sign – Absence of a normal respiratory fall (or increase) with inspiration

Measurement

  • Angle of Louis is 4 cm above the RA (reference point)
  • Measure the height of the JVP above the angle from the highest point (generally on inspiration).
  • > 3cm ASA, then ↑ JVP

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