JVP

Function at waveform points

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• Atrial filling

• Systole

• Klosed tricuspid

• Maximal atrial filling

• Emptying of atrium

Abnormalities of the JVP

• • Raised JVP with normal waveform

    • right heart failure

    • fluid overload

    • bradycardia

  • Raised JVP with absent pulsation

    • SVC obstruction - full dilated jugular veins, no pulsation, oedematous face and neck

  • Large a wave

    • tricuspid stenosis - atria contracts against stiff tricuspid and so pressure in atria rises higher than normal

      • pulmonary hypertension - there are generally higher pressures on the right side of the heart

      • pulmonary stenosis

  • Extra-large a wave = Cannon wave

    • Occurs when atrium contracts against closed tricuspid

      • complete heart block

      • atrial flutter

      • single chamber pacing

      • nodal rhythm (AV node is in charge)

      • ventricular extra-systole

      • ventricular tachycardia ie any condition in which the atria and the ventricles are not conducting in appropriate rhythm

  • Absent a wave

    • atrial fibrillation

  • Systolic waves = combined c-v waves = big v waves

    • tricuspid regurgitation (c-v wave because the pressure in the right atrium is raised throughout ventricular systole - tip is to watch for earlobe movement!)

  • Slow y descent

    • Tricuspid stenosis (if the HR is so low as to allow the length of descent to be appreciated!)

  • Paradoxical JVP = Kussmaul's sign

    • Normally the JVP should rise on expiration and fall on inspiration.

    • When the JVP rises on inspiration it indicates

      • pericardial effusion

    • constrictive pericarditis

    • pericardial tamponade

Hepatojugular Reflex

• • Press firmly over either the right upper quadrant of the abdomen (i.e., over the liver) or over the center of the abdomen ^[1] for 10–60 seconds with a pressure of 20 to 35 mm Hg

    • Be sure the patient does not perform a Valsalva maneuver ^[2].

  • On an otherwise healthy individual, the jugular venous pressure remains constant or temporarily rises for a heartbeat or two, before returning to normal.

  • A positive result is variously defined as either a sustained rise in the JVP of at least 4 cm or more ^[2] or a fall of 4 cm or more ^[1] after the examiner releases pressure.

  • Patients with a positive response had lower left ventricular ejection fractions and stroke volumes, higher left ventricular filling pressure, higher mean pulmonary arterial, and higher right atrial pressures.[3]

  • The abdominojugular test, when done in a standardized fashion, correlates best with the pulmonary arterial wedge pressure, and therefore, is probably a reflection of an increased central blood volume.

    • In the absence of isolated right ventricular failure a positive abdominojugular test suggests a pulmonary artery wedge pressure of 15 mm Hg or greater.[3]

Pictures