Jugular venous pulse

15 Jugular venous pulse



Instruction


Examine this patient’s neck.


Examine this patient’s cardiovascular system.



Salient features



History




• Shortness of breath


• Symptoms of right heart failure (leg oedema, ascites).



Examination




• The JVP is measured ….. cm above the angle of Louis (manubriosternal angle). Remember that the distance between the angle of Louis and the mid-right atrium can be varied and the JVP may be measured as high as at the level of the ear lobes.


• Comment on the waveform (timing it with the carotid pulse):


• ‘v’ waves of tricuspid regurgitation

• Cannon waves of heart block

• Absent ‘a’ waves in atrial fibrillation (irregular carotid pulse)

• Large ‘a’ waves of pulmonary hypertension, pulmonary stenosis, tricuspid stenosis.

• Check the hepatojugular reflex.


• Tell the examiner that you would like to look for other signs of heart failure:


• Basal crackles and pleural effusion

• Dependent oedema (ankle and sacral oedema)

• Tender hepatomegaly.


Diagnosis


This patient has raised jugular venous pulse with ‘v’ waves (lesion) caused by tricuspid regurgitation (see Case 19) and is in heart failure (functional status).



Questions




What are the causes of a raised jugular venous pulse?




• Congestive cardiac failure (N Engl J Med 2001;345:574–81)


• Cor pulmonale


• Tricuspid regurgitation (prominent ‘v’ waves)


• Tricuspid stenosis (prominent ‘a’ waves)


• Complete heart block (cannon waves)


• Non-pulsatile neck veins seen in superior venal caval obstruction (p. 796).

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Jugular venous pulse

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