Jugular venous distention resident survival guide: Difference between revisions
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{{familytree | | |!| | | |,|-|-|^|-|-|-|-|.|}} | {{familytree | | |!| | | |,|-|-|^|-|-|-|-|.|}} | ||
{{familytree | | C01 | | C02 | | C03 | | C04 |C01=<div style="float: Center; text-align: Center; width:12em; padding:1em;"> | {{familytree | | C01 | | C02 | | C03 | | C04 |C01=<div style="float: Center; text-align: Center; width:12em; padding:1em;"> | ||
[[Congestive heart failure]] | |||
|C02=<div style="float: Center; text-align: Center; width:12em; padding:1em;"> '''Increased right atrial pressure''' | |C02=<div style="float: Center; text-align: Center; width:12em; padding:1em;"> '''Increased right atrial pressure''' | ||
|C03=<div style="float: Center; text-align: Center; width:12em; padding:1em;"> '''Venous obstruction''' | |C03=<div style="float: Center; text-align: Center; width:12em; padding:1em;"> '''Venous obstruction''' | ||
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❑ '''Tricuspid valve stenosis or obstruction'''|D02=<div style="float: Center; text-align: Center; width:20em; padding:1em;"> | ❑ '''Tricuspid valve stenosis or obstruction'''|D02=<div style="float: Center; text-align: Center; width:20em; padding:1em;"> | ||
❑ '''Superior vena cava obstrcution'''|D03=<div style="float: Center; text-align: Center; width:20em; padding:1em;"> | ❑ '''Superior vena cava obstrcution'''|D03=<div style="float: Center; text-align: Center; width:20em; padding:1em;"> | ||
❑ '''Positive pressure ventilation''' | ❑ '''[[Positive pressure ventilation]]''' | ||
❑ '''A large [[pleural effusion]]''' | ❑ '''A large [[pleural effusion]]''' | ||
❑'''[[Tension Pneumothorax]]'''}} | ❑'''[[Tension Pneumothorax]]'''}} | ||
Revision as of 18:06, 30 August 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Jugular venous distension (JVD), or an elevated jugular venous pressure (JVP), is considered a useful physical finding for assessing ventricular filling pressures and central venous pressure (CVP). JVD is defined as an estimated JVP ≥10 cm H2O.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
- Acute heart failure
- Massive pulmonary emboli
- Right ventricular myocardial infarction
- Cardiac Tamponade
- Tension Pneumothorax
Common Causes
Diagnosis
Shown below is an algorithm summarizing the diagnosis of jugular venous distension according to the ACC and ESC guidelines.
With pulmonary edema | Without pulmonary edema | ||||||||||||||||||||||||||||||
Increased right atrial pressure | Venous obstruction | Increased intrathoracic pressure | |||||||||||||||||||||||||||||
❑ Restriction of right atrial and right ventricular filling:
❑RV Failure: ❑ Fluid overload due to renal diseases ❑ Tricuspid valve incompetence ❑ Tricuspid valve stenosis or obstruction |
❑ Superior vena cava obstrcution | ||||||||||||||||||||||||||||||
Treatment
The management of jugular venous distension should be directed towards the underlying causes.
Do's
- If the JVP does not seem elevated when the patient is supine, a provocative test, i.e., abdominojugular test, should be performed.
Don'ts
- JVD only provides clues to the presence of an elevated CVP. Clinicians should avoid making decisions about the degrees of CVP elevation based on the JVP measurement.