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