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Jugular Venous Pressure (JVP)

by | 20 May, 2020

Introduction

The jugular venous pressure (JVP) refers to the pressure in the internal jugular veins. The height of the JVP reflects right heart pressure and function.

Practicalities of interpretation

Patients should be positioned at 45° to the horizontal when measuring the JVP. The JVP is easiest to observe along the sternocleidomastoid muscle.

Filling of the internal jugular 3 cm or higher above the angle Louis (sternal angle) is considered as elevated JVP.

Differences from carotid pulse

The JVP can be confused with the carotid pulse. Clinical features of the JVP include:

  • Non-palpable
  • Readily occludable – pressing on the vessel should stop the JVP. It can be observed that the vein fills from above
  • Multiphasic – the JVP has 2 peaks for every heartbeat
  • Decreases with respiration – inspiration decreases thoracic pressure, leading to increased venous return to the right heart and the pulmonary circulation

JVP waveforms

The waveforms of the JVP can be observed in invasive central venous pressure (CVP) monitoring. Changes in JVP waveforms may suggest pathology. Normal waveforms include:

a wave: atrial contraction

c wave: ventricular contraction

x descent: atrial relaxation

v wave: atrial venous filling (against close tricuspid valve)

y descent: tricuspid valve opening

JVP normal
Normal JVP waveforms

Abnormal JVP waveforms

Absent a waves

JVP absent a
Absent a wave in the JVP

Cause: Atrial fibrillation

Cannon a waves

JVP Cannon a
Cannon a wave in the JVP

Cannon a waves occur when the atria and ventricle contract simultaneously, producing a greatly elevated a wave.

Causes:

 Large a wave

JVP Large a
Large a wave in the JVP

Causes:

Constrictive pericarditis vs Tamponade

The main method of differentiating tamponade from constrictive pericarditis on JVP is by observing the x and y descent. Tamponades produce sharp x descent only, whilst constrictive pericarditis produces sharp x and y descent.

Constrictive pericarditis

JVP features:

  • Sharp x and y descent
  • Large v wave

Tamponade

JVP features:

  • Sharp x descent only
  • Large v wave

Abnormal JVP height

Elevated JVP with normal waves

Causes:

  • Fluid overload
  • Heart failure

Elevated JVP with no waves present

Cause: Superior vena cava obstruction

Absent JVP

Cause: Hypovolaemia

Kussmaul’s sign

Normally, the JVP should go down with inspiration as a result of the drop in intrathoracic pressure. Kussmaul’s sign is an abnormal finding that refers to the JVP paradoxically rising with inspiration. It is seen in conditions affecting right heart function. During inspiration in right heart dysfunction, there is an increase in venous return but the heart cannot effectively pump it through the pulmonary circulation, leading to JVP elevation.

Causes:

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