Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Examination of JVP PowerPoint PPT presentation
? Done in good light
? Patient is reclining at 45 degree
? Head is supported and turned to left
? JVP is visible along line of sternocleidomastoid muscle
? JVP is the height of vertical column of blood in the internal
juglar vein above the angle of Lewis measured in cm.
STEPS
? Scale is placed vertically from angle of Lewis
? Second scale is placed horizontally at upper level of
vertical oscillating column of blood.
? Distance from angle of Lewis to horizontal scale is
measured in cm.
? Normal JVP is 4 cm.
? Reading more than 4cm indicates raised right arterial
pressure unless superior vena cava is obstructed.
Identifying waves
? Examiner should stand on right side of patient who is
inclined at an angle of 45 degree.
? First identify pulsations and time the wave with carotid
pulse by simultaneously palpating left carotid artery with
left hand,which is passed behind patient's neck.
? a wave-comes before carotid pulse
? sharp flicker
? V wave-comes with carotid pulse or following carotid
pulse,
? undulating character
CHARACTERISTICS OF JVP
? Double waveform
? Varies with respiration
? Varies with posture
? Impalpable
? Obliterated by pressure at base of waveform
? Transient increase in volume and height with hepatojuglar
reflex
HEPATOJUGLAR REFLEX
? Patient lie at 45 degree inclination
? Examiner should stand on right side of patient and apply
firm pressure over upper right side of abdomen for 10
seconds.
? Patient is asked to breathe normally and not to strain
? There is transient increase in venous return which will
elevate JVP.
? Normal individuals ?rise is less than 4cm returning to
normal in less than 4 cardiac cycles.
? Right heart failure-sustained elevation of more than 4 cm.
? False elevation can occur in COPD due to altered
intrathoracic pressure conditions associated with
generalised vasoconstriction.
Kusmauls sign
? During inspiration pressure within chest decreases and
there is fall in JVP.
? In constrictive pericarditis and less commonly in
tamponade ,inspiration produces a paradoxical rise in JVP.
? Because increased venous return cannot be accomodated
within constrained right side of heart.
ELEVATED JVP
? Congestive heart failure
? Cor pulmonale
? Pulmonary embolism
? Right ventricular infarction
? Tricuspid valve disease
? Tamponade
? Constrictive pericarditis
? Hypertrophic/restrictive cardiomyopathy
? Superior vena cava obstruction
? Iatrogenic fluid overload-as in renal patients
ALTERED WAVEFORM
? Atrial fibrillation-there is no atrial contraction
? No `a' wave
? JVP loses its double waveform
This post was last modified on 12 August 2021