Jugular venous distention resident survival guide

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Jugular venous distention Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mitra Chitsazan, M.D.[2] Mandana Chitsazan, M.D. [3]

Synonyms and Keywords: Approach to Jugular venous distension, JVD workup, Approach to JVD, Approach to elevated jugular vein pressure, Elevated JVP algorithm, Elevated JVP workup

Overview

Jugular venous pressure (JVP) is considered the most useful finding for assessing the ventricular filling pressures and central venous pressure (CVP) at the bedside. The jugular venous pressure is measured as the vertical distance between the top of venous pulsation and the angle of Louise, i.e., where the manubrium meets the body of the sternum. A distance of >3cm is considered jugular venous distension (JVD) or an elevated jugular venous pressure (JVP).

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. [1]

Common Causes

Common causes of jugular venous distension include: [2] [3]

Diagnosis

Shown below is an algorithm summarizing the diagnosis of jugular venous distension. [4] [5] [3] [6]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Without pulmonary edema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Increased right atrial pressure
 
Venous obstruction
 
Increased intrathoracic pressure
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Restriction of right atrial and right ventricular filling:

Cor pulmonale (Massive pulmonary emboli, COPD)
Pulmonary Hypertension
Pulmonary valve stenosis
Constrictive pericarditis
Cardiac Tamponade

RV Failure:

Cardiomyopathy
RV myocardial infarction

Fluid overload due to renal diseases

Tricuspid valve incompetence

Tricuspid valve stenosis or obstruction
 
Superior vena cava obstrcution
 

Treatment

Do's

Don'ts

  • JVD only provides clues to the presence of an elevated central venous pressure (CVP). [3]
  • Clinicians should avoid making decisions about the degrees of CVP elevation based on the JVP measurement.

References

  1. Thibodeau JT, Drazner MH (2018). "The Role of the Clinical Examination in Patients With Heart Failure". JACC Heart Fail. 6 (7): 543–551. doi:10.1016/j.jchf.2018.04.005. PMID 29885957.
  2. Jolobe OM (2011). "Disproportionate elevation of jugular venous pressure in pleural effusion". Br J Hosp Med (Lond). 72 (10): 582–5. doi:10.12968/hmed.2011.72.10.582. PMID 22041729.
  3. 3.0 3.1 3.2 McGee SR (1998). "Physical examination of venous pressure: a critical review". Am Heart J. 136 (1): 10–8. doi:10.1016/s0002-8703(98)70175-9. PMID 9665212.
  4. Butman SM, Ewy GA, Standen JR, Kern KB, Hahn E (1993). "Bedside cardiovascular examination in patients with severe chronic heart failure: importance of rest or inducible jugular venous distension". J Am Coll Cardiol. 22 (4): 968–74. doi:10.1016/0735-1097(93)90405-p. PMID 8409071.
  5. Devine PJ, Sullenberger LE, Bellin DA, Atwood JE (2007). "Jugular venous pulse: window into the right heart". South Med J. 100 (10): 1022–7, quiz 1004. doi:10.1097/SMJ.0b013e318073c89c. PMID 17943049.
  6. Dell'Italia LJ, Starling MR, O'Rourke RA (1983). "Physical examination for exclusion of hemodynamically important right ventricular infarction". Ann Intern Med. 99 (5): 608–11. doi:10.7326/0003-4819-99-5-608. PMID 6638720.
  7. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM; et al. (2017). "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America". J Am Coll Cardiol. 70 (6): 776–803. doi:10.1016/j.jacc.2017.04.025. PMID 28461007.
  8. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA; et al. (2013). "2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 61 (4): e78–e140. doi:10.1016/j.jacc.2012.11.019. PMID 23256914.
  9. MacDuff A, Arnold A, Harvey J, BTS Pleural Disease Guideline Group (2010). "Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010". Thorax. 65 Suppl 2: ii18–31. doi:10.1136/thx.2010.136986. PMID 20696690.
  10. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N; et al. (2014). "2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism". Eur Heart J. 35 (43): 3033–69, 3069a–3069k. doi:10.1093/eurheartj/ehu283. PMID 25173341.
  11. Ducas J, Magder S, McGregor M (1983). "Validity of the hepatojugular reflux as a clinical test for congestive heart failure". Am J Cardiol. 52 (10): 1299–303. doi:10.1016/0002-9149(83)90592-1. PMID 6650420.