This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.
Description
Jugular venous pressure (JVP) provides an indirect measure of central venous pressure. The internal jugular vein connects to the right atrium without any intervening valves - thus acting as a column for the blood in the right atrium. The JVP consists of certain waveforms and abnormalities of these can help to diagnose certain conditions.1 Unfortunately, detection of these abnormalities and even the JVP itself, can be difficult and has also been superseded by other diagnostic methods.
The patient's head should be turned slightly to the left.
If possible, have a tangential light source that shines obliquely from the left.
Locate the surface markings of the IJV - this runs from the medial end of the clavicle to the ear lobe, under the medial aspect of the sternocleidomastoid.
Locate the JVP - look for the double waveform pulsation (palpating the contralateral carotid pulse will help).
Measure the level of the JVP by measuring the vertical distance between the sternal angle and the top of the JVP. Measure the height - usually less than 3 cm.
Waveforms of jugular venous pressure
For a diagram, see 'JVP Waveforms' under 'Document references', below.5
a - presystolic; produced by right atrial contraction.
c - bulging of the tricuspid valve into the right atrium during ventricular systole (isovolumic phase).
v - occurs in late systole; increased blood in the right atrium from venous return.
Descents
x - a combination of atrial relaxation, downward movement of the tricuspid valve and ventricular systole.
y - the tricuspid valve opens and blood flows into the right ventricle.
The a and v waves can be identified by timing the double waveform with the opposite carotid pulse. The a wave will occur just before the pulse and the v wave occurs towards the end of the pulse. Distinguishing the c wave, x and y descents is an almost impossible task.
How to differentiate a jugular venous pulse from the carotid pulse
The jugular venous pulse is:
Not palpable.
Obliterated by pressure.
Characterised by a double waveform.
Variable with respiration - it decreases with inspiration.
Large a waves occur in any cause of right ventricular hypertrophy (pulmonary hypertension and pulmonary stenosis) and tricuspid stenosis.
Extra large a waves (called cannon waves) in complete heart block and ventricular tachycardia.
Prominent v waves
Tricuspid regurgitation - called cv or v waves and occurring at the same time as systole (a combination of v wave and loss of x descent); there may be earlobe movement.
(The last two conditions have a rapid rise and fall of the JVP - called Friedreich's sign.)
Prognostic use of jugular venous pressure
Elevated JVP in patients with heart failure is associated with an increased risk of hospital admission, death and subsequent hospitalisation for heart failure.7 Therefore, appreciation of this sign can be clinically helpful.
Document references
Jevon P, Cunnington A; Cardiovascular examination. Part one of a four-part series. Measuring jugular venous pressure. Nurs Times. 2007 Jun 19-25;103(25):28-9.
Kumar P; Clarke M; Clinical Medicine, 6th Ed, (2005). WB Saunders: London
Harrison's Principles of Internal Medicine, 15th Ed. Eds: Braunwald, E et al. McGraw-Hill, USA, 2001
Souhami, RL and Moxham, J (Eds). Textbook of medicine, 4th edition, (2002), Churchill Livingstone: China
JVP Waveforms, University of California - Hospitalist Handbook, 2002; provides a good image of jugular venous pulsations
Wiese J; The abdominojugular reflux sign. Am J Med. 2000 Jul;109(1):59-61. [abstract]
Drazner MH, Rame JE, Stevenson LW, et al; Prognostic importance of elevated jugular venous pressure and a third heart sound in patients with heart failure. N Engl J Med. 2001 Aug 23;345(8):574-81. [abstract]
Sign in