Jugular venous pulse is the oscil ating
top of the distended proximal
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portion of the internal jugular veinand represents volumetric changes
that reflect the pressure changes in
the right heart.
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ANATOMY
The internal jugular vein runs deep to
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the sternocleidomastoid muscle andenter the thorax between the sternal
and clavicular heads.
The external jugular vein is more
superficial and prominent.
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Right IJV Preferred
? Straight line course through innominate
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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
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EJVThe JVP level reflects right atrial
pressure(normal y less than 7mmHg).The
sternal angle is approximately 5 cm above
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right atrium ,so the JVP should be normal yless than or equal to 4 cm above this angle
when the patient lies at 45 degrees.
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NORMAL JVP
Normal JVP reflects phasic pressure
changes in right atrium during systole
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and right ventricle during diastole.Normal JVP waveform consists of
3 positive waves ?a ,c and v
3 descents ?x ,x' and y
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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
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? Has two peaks and two troughsHas single upstroke only
? Descents >obvious than crests
Upstroke brisker and visible
? Digital compression abolishes venous
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Digital compression has no effectpulse
? Jugular venous pressure fal s during
Do not change with respiration
inspiration
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? Abdominal compression elevatesAbdominal compression has no effect on
jugular pressure
carotid pulse
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a Wave
? First positive presystolic a wave is
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due to right atrial contraction.? Effective right atrial contraction is
needed for visible a wave.
? Dominant wave in JVP and larger
than v
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? It precedes upstroke of carotid pulseand S1, but fol ow the P wave in ECG
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x Descent
? Systolic x descent is due to atrial
relaxation during atrial diastole.
? X descent is the most prominent
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motion of normal JVP which beginsduring systole and ends just before
S2.
? It is larger than y descent.
? X descent is more prominent during
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c Wave? Not usual y visible.
? Causes-
Transmitted carotid artery pulsation.
Upward bulge of closed tricuspid
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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
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valve by contracting right ventricle.Descent of right atrial floor
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v Wave
? Begins in late systole and ends in
early diastole
? Cause- rise in RA pressure due to
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continued right atrial fil ing duringventricular systole when tricuspid
valve is closed.
? Roughly synchronous with carotid
upstroke and corresponds to S2.
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y descent
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? Diastolic col apse wave(down slope vwave)
? It begins and ends during diastole
well after S2
? Cause-decline of right atrial pressure
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due to right atrial emptying duringearly diastole when tricuspid valve
opens
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h Wave
? Smal brief positive wave fol owing y
descent just prior to a wave
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? Usual y seen when diastole is long? With increasing heart rate , y
descent is immediately fol owed by a
wave
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RESPIRATORY INFLUENCES
oInspiration- increased visibility of
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venous pulseoWaves become more prominent
during inspiration
oX descent more brisk
(due to increased venous return).
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