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From Philips. Examination Chapter. From Related Chapters. Pharmacology Herbals Affecting Blood Pressure. Page Contents Page Contents Technique: Jugular Venous Pressure measurement Examine position Head of bed elevated at 45 degree angle Head turned to right Identify top of venous pulsation in neck JVP Jugular Venous Pulsations are inward Contrast with outward Carotid Artery pulsations Identify the sternal angle Angle of Louis Located at superior edge or notch of Sternum Measure distance between top of pulsation and Sternum Measured in centimeters.
References Bates Physical Exam, p. Images: Related links to external sites from Bing. Related Studies. Trip Database TrendMD. Ontology: Hepatojugular reflux C Ontology: Paradoxical inspiratory filling of neck veins C Concepts Sign or Symptom T SnomedCT English Kussmaul's sign , Paradox insp filling neck vein , kussmauls signs , kussmaul sign , kussmaul's sign , Paradoxical inspiratory filling of neck veins , Paradoxical inspiratory filling of neck veins finding Spanish signo de Kussmaul hallazgo , signo de Kussmaul.
Differences between the venous pulsation of the JVP and the arterial pulsation of the carotid artery include:. The double waveform pulsation associated with the JVP reflects pressure changes within the right atrium.
Think of the pressure changes as a Mexican wave; starting in the right atrium and travelling to the IJV where we observe the pulsations. Ask the patient to turn their head slightly to the left.
Inspect for evidence of the IJV, running between the medial end of the clavicle and the ear lobe, under the medial aspect of the sternocleidomastoid it may be visible just above the clavicle between the sternal and clavicular heads of the sternocleidomastoid. The IJV has a double waveform pulsation, which helps to differentiate it from the pulsation of the external carotid artery. Measure the JVP by assessing the vertical distance between the sternal angle and the top of the pulsation point of the IJV in healthy individuals, this should be no greater than 3cm.
The hepatojugular reflux test involves the application of pressure to the liver whilst observing for a sustained rise in JVP. This test can be used to further assess the JVP, particularly if you are unsure if the vessel you are observing is the internal jugular vein.
To be able to perform the test, there should be at least a 3cm distance from the upper margin of the baseline JVP to the angle of the mandible :. A raised JVP indicates the presence of venous hypertension. Cardiac causes of a raised JVP include:. The A wave is caused by the contraction of the right atrium, where blood is being pumped through the tricuspid valve into the right ventricle.
Increased pressure in the right atrium also forces blood upwards towards and into the IJV. This influx of venous blood into the IJV is known as the A wave. The first part of the X descent is caused by relaxation of the right atrium , which results in blood filling the right atrium from the superior vena cava, reducing the height of the column of blood sitting in the IJV i.
The right ventricles relaxation also contributes to the X descent, as blood exits the right atrium into the right ventricle, further reducing the column of blood in the SVC and IJV. The C wave is caused by the forceful contraction of the right ventricle which ejects blood out of the heart into the pulmonary artery. As this occurs, the pressure within the right ventricle increases significantly, forcing the tricuspid valve upwards so much so that it projects partially into the right atrium.
This sudden projection of the tricuspid valve into the right atrium generates upwards force which is transmitted into the SVC and ultimately the IJV, causing a temporary rise in the JVP referred to as the C wave. The second part of the X descent occurs during the final phase of right ventricular contraction.
When the ventricle reaches its most contracted state, it is physically much smaller than when in its relaxed state, resulting in the creation of extra space within the pericardium. This extra space within the pericardium allows the right atrium to expand and begin filling with blood. This initial phase of atrial filling results in a drop in venous pressure within the SVC and IVC, producing the second part of the X descent.
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