Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Jugular Venous Pulse PowerPoint PPT presentation
Jugular venous pulse is the oscil ating
top of the distended proximal
portion of the internal jugular vein
and represents volumetric changes
that reflect the pressure changes in
the right heart.
ANATOMY
The internal jugular vein runs deep to
the sternocleidomastoid muscle and
enter the thorax between the sternal
and clavicular heads.
The external jugular vein is more
superficial and prominent.
Right IJV Preferred
? Straight line course through innominate
vein to the svc and right atrium
? Less likely extrinsic compression from
other structures in neck
Why not EJV
? No or less numbers of valves in IJV than
EJV
The JVP level reflects right atrial
pressure(normal y less than 7mmHg).The
sternal angle is approximately 5 cm above
right atrium ,so the JVP should be normal y
less than or equal to 4 cm above this angle
when the patient lies at 45 degrees.
NORMAL JVP
Normal JVP reflects phasic pressure
changes in right atrium during systole
and right ventricle during diastole.
Normal JVP waveform consists of
3 positive waves ?a ,c and v
3 descents ?x ,x' and y
differences between JVp and carotid pulse
? Superficial and lateral in the neck
Deeper and medial in the neck
? Better seen than felt
Better felt than seen
? Has two peaks and two troughs
Has single upstroke only
? Descents >obvious than crests
Upstroke brisker and visible
? Digital compression abolishes venous
Digital compression has no effect
pulse
? Jugular venous pressure fal s during
Do not change with respiration
inspiration
? Abdominal compression elevates
Abdominal compression has no effect on
jugular pressure
carotid pulse
a Wave
? First positive presystolic a wave is
due to right atrial contraction.
? Effective right atrial contraction is
needed for visible a wave.
? Dominant wave in JVP and larger
than v
? It precedes upstroke of carotid pulse
and S1, but fol ow the P wave in ECG
x Descent
? Systolic x descent is due to atrial
relaxation during atrial diastole.
? X descent is the most prominent
motion of normal JVP which begins
during systole and ends just before
S2.
? It is larger than y descent.
? X descent is more prominent during
inspiration.
c Wave
? Not usual y visible.
? Causes-
Transmitted carotid artery pulsation.
Upward bulge of closed tricuspid
valve in isovolumic systole.
x' Descent
? Systolic trough after c wave.
? Due to fal of the right atrial pressure
during early right ventricular systole
Downward pulling of the tricuspid
valve by contracting right ventricle.
Descent of right atrial floor
v Wave
? Begins in late systole and ends in
early diastole
? Cause- rise in RA pressure due to
continued right atrial fil ing during
ventricular systole when tricuspid
valve is closed.
? Roughly synchronous with carotid
upstroke and corresponds to S2.
y descent
? Diastolic col apse wave(down slope v
wave)
? It begins and ends during diastole
well after S2
? Cause-decline of right atrial pressure
due to right atrial emptying during
early diastole when tricuspid valve
opens
h Wave
? Smal brief positive wave fol owing y
descent just prior to a wave
? Usual y seen when diastole is long
? With increasing heart rate , y
descent is immediately fol owed by a
wave
RESPIRATORY INFLUENCES
oInspiration- increased visibility of
venous pulse
oWaves become more prominent
during inspiration
oX descent more brisk
(due to increased venous return).
This post was last modified on 12 August 2021