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Jugular Venous PressureBy:- Dr. Ankur Gupta

IntroductionOscillating top of the distended proximal portion of the internal jugular vein (IJV).

Represents volumetric changes that faithfully reflect the pressure changes in the right side of heart.

Useful in the differentiation of different forms ofheartandlung disease.

Classically three upward deflections and two downward deflections:Upward deflections: a, c and v.Downward deflections: x and y.

Pulsations and pressure waves in jugular veins:Right atrial pressure during systole.Right ventricular filling pressure during diastole.

Evaluation of JVP offers a window into the right heart, providing critical information regarding its hemodynamics.

Right atrial pressure during systole and right ventricular filling pressure during diastole are producing pulsations and pressure waves in jugular veins .Evaluation of the jugular venous pulse offers a window into the right heart, providing critical information regarding its hemodynamics.

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Jugular veins

Internal jugular vein

External jugular vein

Two jugular veins int and ext can be used 4 assessing jv pulse and pressure, though internal one is the preffered one4

The internal jugular vein begins just medial to the mastoid process at the base of the skull. The internal jugular vein runs directly inferior from the mastoid process,. it joins the subclavian vein, to form r innominate which continue as superior vena cava and then into the right atrium.5

Lateral to carotid artery & deep to SCM.

External jugular is superficial to SCM.

The internal jugular vein is 6

Examination of JVPDone bedside to assess CVP and waveform.

Right IJV for waveform and estimation of venous pressure.

Unlike EJV pulsations, it is not possible to see IJV pulsations directly as it is deep within the neck and covered by SCM.

Actually seen are the transmitted pulsations to overlying skin and soft tissues.

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IJV preferred to EJVAnatomically, IJVs are closer to RA. Take a direct course (straight line) to SVC and RA.More accurately reflect the dynamics of the Right Heart.

Transmission of RA pulsations prevented by prominent valves at the proximal EJV.

Other structures of neck and upper thorax causes extrinsic compression of EJV.

Sympathetic activity (as in CCF) vasoconstriction of EJV Pulsations are barely visible.

Right IJV Preferred to Left IJVRt. IJVStraight line course through innominate vein to the SCV and RA.Less likely extrinsic compression from other structures in neck.

Lt. IJVLeft innominate vein may be compressed by dilated aorta or an aneurysm.Drains into left innominate vein, which is not in straight line from SVC and RA.

10Left IJV Usually rijv s pref 4 jvp examination. RIJV is less likely affected by extrinsic compression from other structures in neck. Left inno compresssed by arch f aorta and presence of left svc can falsely elevate the jvp on left side. So in conditions with increased symp tone ejv pulsations less visible. Left IJV drains into left innominate vein, which is not in straight line from RA

Differences between JVP and Carotid pulsationsJVPCarotid PulsationsSuperficial and lateral in the neck.Deeper and medial in neck. Better seen than felt.Better felt than seen.Two peaks and troughs per cardiac cycle.Single upstroke.Descents more prominent than crests.Upstroke brisker and visible than descent. x and y more prominent during inspiration.No effect.a and v transiently during expiration.No effect.

JVP falls during inspiration.No effect.Digital compression at the root of neck abolishes JVP.No effect.

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multiphasic- the JVP "beats" twice (in quick succession) in thecardiac cycleThere are two waves in the JVP for each contraction-relaxation cycle by the heart. The first beat represents that atrial contraction (termeda).The second beat represents venous filling of the right atrium against a closed tricuspid valve (termedv).The carotid artery only has one beat in the cardiac cycle.

Measurement of JV Pressure

Sternal angle or angle of Louis - reference point.

Found approximately 5 cm above the center of the right atrium.

Sternal angle RA Fixed relationship.

13Sternal angle or angle of Louis is a surface anatomical mark reference point used for JVP measurementDistance between sternal angle and center of right atrium remains relatively constant regardless of position of the thorax

Level of sternal angle is about 5 cm above the level of mid right atrium IN ANY POSITION.

Examined in ANY position in which top of the column is seen easily.