Definition Definition Jugular Venous Pulse: Jugular Venous Pulse: defined as the defined as the oscillating top of vertical oscillating top of vertical column of blood in right IJV that column of blood in right IJV that reflects pressure changes in Right reflects pressure changes in Right Atrium in cardiac cycle. Atrium in cardiac cycle. Jugular Venous Pressure: Jugular Venous Pressure: Vertical height of Vertical height of oscillating column of blood. oscillating column of blood.
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Definition Jugular Venous Pulse: Jugular Venous Pulse: defined as the oscillating top of vertical column of blood in right IJV that reflects pressure changes.
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DefinitionDefinition
Jugular Venous Pulse:Jugular Venous Pulse:
defined as the oscillating top of vertical defined as the oscillating top of vertical column of blood in right IJV that reflects column of blood in right IJV that reflects pressure changes in Right Atrium in cardiac pressure changes in Right Atrium in cardiac cycle.cycle.
Jugular Venous Pressure:Jugular Venous Pressure:
Vertical height of oscillating column of Vertical height of oscillating column of blood.blood.
IJV has a direct course to RA.IJV has a direct course to RA. IJV is anatomically closer to RA.IJV is anatomically closer to RA. IJV has no valves( Valves in EJV prevent IJV has no valves( Valves in EJV prevent
transmission of RA pressure)transmission of RA pressure) Vasoconstriction Secondary to hypotension Vasoconstriction Secondary to hypotension
( in CCF) can make EJV small and barely ( in CCF) can make EJV small and barely visible.visible.
Why Right Internal Jugular Vein?Why Right Internal Jugular Vein?
Right jugular veins extend in an almost straight line to superior vena cava, thus favouring transmission of the haemodynamic changes from the right atrium.
The left innominate vein is not in a straight line and may be kinked or compressed between Aortic Arch and sternum, by a dilated aorta, or by an aneurysm.
Difference from Carotid PulseDifference from Carotid PulseVenous PulseVenous Pulse Carotid PulseCarotid Pulse
Better viewed from foot Better viewed from foot end of bedend of bed
Method Of ExaminationMethod Of Examination
The patient should lie comfortably during the examination.
Clothing should be removed from the neck and upper thorax. Patient reclining with head elevated 45 °
Neck should not be sharply flexed.
Examined effectively by shining a light tangentially across the neck.
There should not be any tight bands around abdomen
Observations MadeObservations Made
the level of venous pressure.
the type of venous wave pattern.
The level of venous pressure
Using a centimeter ruler, measure the vertical distance between the angle of Louis (manubrio sternal joint) and the highest level of jugular vein pulsation.
The upper limit of normal is 4 cm above the sternal angle,.
Add 5 cm to measure central venous pressure since right atrium is 5 cm below the sternal angle.
Normal CVP is < 9 cm H2O
Normal pattern of the jugular venous pulse
The normal JVP reflects phasic pressure changes in the right atrium and consists of three positive waves and two negative troughs
Simultaneous palpation of the left carotid artery aids the examiner in relating the venous pulsations to the timing of the cardiac cycle.
Venous distension due to RA contractionVenous distension due to RA contraction Retrograde blood flow into SVC and IJVRetrograde blood flow into SVC and IJV Synchronous with S1, Follow P of ECGSynchronous with S1, Follow P of ECG Precede Carotid pulsePrecede Carotid pulse
a WAVEa WAVE
The x descent: is due to X Atrial relaxation X` Descent of the floor of the right atrium during right ventricular systole. Begins during systole and ends before S2
The c wave: Occurs simultaneously with the carotid pulse Artifact by Carotid pulsation Bulging of TV into RA during ICP
v WAVEv WAVE
Rising right atrial pressure when blood flows into the right atrium during ventricular systole when the tricuspid valve is shut.
Synchronous with Carotid pulse Begins in early systole, Peaks after S2 and ends in early
diastole
y DESCENTy DESCENT
The decline in right atrial pressure when the tricuspid valve reopens
Following the bottom of the y descent and before beginning of the a wave is a period of relatively slow filling of the ventricle, the diastases period, a wave termed the h wave.
The x descent occurs just prior to the second heart sound ( during systole), while the y descent occurs after the second heart sound (during diastole).
Normally X descent is more prominent than Y descent. Y descent is only sometimes seen during diastole. Descents are better seen than positive waves.
The a wave occurs just before the first sound or carotid pulse and has a sharp rise and fall.
The v wave occurs just after the arterial pulse and has a slower undulating pattern.
The c wave is never seen normally.The c wave is never seen normally.
Identifying Wave FormsIdentifying Wave Forms
Abnormalities of jugular venous pulse
A. Low jugular venous pressure
1. Hypovolaemia.
B. Elevated jugular venous pressure
1. Intravascular volume overload conditions Right ventricular infarction Left heart failure Myocardial infarction. Valvular Heart Disease Cardiomyopathy 2. Constrictive pericarditis.3. Pericardial effusion with tamponade
1. Tricuspid regurgitation.2. Right atrial ischaemia
Prominent “y” descent
1. Constrictive pericarditis.
2. Tricuspid regurgitation.
3. Atrial septal defect.
1. Cardiac tamponade.2. Right ventricular infarction3. Restrictive Cardiomyopathy
Absent “y” descent
Slow “y” descent
1. Tricuspid stenosis.2. Right atrial myxoma.
Constrictive pericarditis.
M shaped contourM shaped contour Prominent X and Y descent (FRIEDREICH`SIGN)Prominent X and Y descent (FRIEDREICH`SIGN) Y descent is prominent as ventricular filling is Y descent is prominent as ventricular filling is
unimpeded during early diastole.unimpeded during early diastole. This is interrupted by a rapid raise in pressure as the This is interrupted by a rapid raise in pressure as the
filling is impeded by constricting Pericardiumfilling is impeded by constricting Pericardium The Ventriclar pressure curve exhibit Square Root signThe Ventriclar pressure curve exhibit Square Root sign
Abdomino-jugular reflux Is positive when JVP increase after 10 sec of abdominal Is positive when JVP increase after 10 sec of abdominal
pressure followed by a rapid drop in pressure of 4 cm on pressure followed by a rapid drop in pressure of 4 cm on release of compression.release of compression.
Most common cause of a positive test is RHFMost common cause of a positive test is RHF Positive test in: Borderline elevation of JVPPositive test in: Borderline elevation of JVP Silent TRSilent TR Latent RHFLatent RHF