HOW TO EXAMINE
? 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
juglar vein above the angle of Lewis measured in cm.
STEPS
? Scale is placed vertically from angle of Lewis
vertical oscillating column of blood.
? Distance from angle of Lewis to horizontal scale is
measured in cm.
? Normal JVP is 4 cm.
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.
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
pulse,
? undulating character
CHARACTERISTICS OF JVP
? Double waveform
? Varies with posture
? Impalpable
? Obliterated by pressure at base of waveform
? Transient increase in volume and height with hepatojuglar
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
? 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
Kusmauls sign
? During inspiration pressure within chest decreases and
there is fall in JVP.
? In constrictive pericarditis and less commonly in
? Because increased venous return cannot be accomodated
within constrained right side of heart.
ELEVATED JVP
? Congestive heart failure
? Pulmonary embolism
? Right ventricular infarction
? Tricuspid valve disease
? Tamponade
? Hypertrophic/restrictive cardiomyopathy
? Superior vena cava obstruction
? Iatrogenic fluid overload-as in renal patients
ALTERED WAVEFORM
? No `a' wave
? JVP loses its double waveform
? 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
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? JVP is the height of vertical column of blood in the internaljuglar vein above the angle of Lewis measured in cm.
STEPS
? Scale is placed vertically from angle of Lewis
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? Second scale is placed horizontally at upper level ofvertical oscillating column of blood.
? Distance from angle of Lewis to horizontal scale is
measured in cm.
? Normal JVP is 4 cm.
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? Reading more than 4cm indicates raised right arterialpressure 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.
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? First identify pulsations and time the wave with carotidpulse by simultaneously palpating left carotid artery with
left hand,which is passed behind patient's neck.
? a wave-comes before carotid pulse
? sharp flicker
--- Content provided by FirstRanker.com ---
? V wave-comes with carotid pulse or following carotidpulse,
? undulating character
CHARACTERISTICS OF JVP
? Double waveform
--- Content provided by FirstRanker.com ---
? Varies with respiration? Varies with posture
? Impalpable
? Obliterated by pressure at base of waveform
? Transient increase in volume and height with hepatojuglar
--- Content provided by FirstRanker.com ---
reflexHEPATOJUGLAR 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
--- Content provided by FirstRanker.com ---
seconds.? Patient is asked to breathe normally and not to strain
? There is transient increase in venous return which will
elevate JVP.
--- Content provided by FirstRanker.com ---
? 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
--- Content provided by FirstRanker.com ---
generalised vasoconstriction.Kusmauls sign
? During inspiration pressure within chest decreases and
there is fall in JVP.
? In constrictive pericarditis and less commonly in
--- Content provided by FirstRanker.com ---
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
--- Content provided by FirstRanker.com ---
? Cor pulmonale? Pulmonary embolism
? Right ventricular infarction
? Tricuspid valve disease
? Tamponade
--- Content provided by FirstRanker.com ---
? Constrictive pericarditis? Hypertrophic/restrictive cardiomyopathy
? Superior vena cava obstruction
? Iatrogenic fluid overload-as in renal patients
ALTERED WAVEFORM
--- Content provided by FirstRanker.com ---
? Atrial fibrillation-there is no atrial contraction? No `a' wave
? JVP loses its double waveform