Jugular venous pulse: examination and interpretation
THE CONTEXT
Continuity between the internal jugular vein, superior vena cava and right atrium allows jugular venous pulsation to reflect right atrial pressure.
Positioning and pulse height
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Examine the patient at 45°, with the head supported and turned to the left. The jugular venous pulse is visible along the sternocleidomastoid muscle and is normally just visible above the clavicle.
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Pulse height reflects right atrial pressure: it rises in right heart failure and falls in hypovolaemia.
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Firm abdominal pressure may expose a jugular venous pulse that is difficult to see.
Waves and descents
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In sinus rhythm, the a and v waves approximate to atrial and ventricular systole, respectively.
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The x descent reflects atrial relaxation and apical displacement of the tricuspid valve ring.
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The y descent reflects atrial emptying early in diastole. These waveform signs are subtle.
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Tricuspid regurgitation produces giant v waves coinciding with ventricular systole.
Distinguishing venous from arterial neck pulsation
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The venous pulse has two peaks per cardiac cycle; the arterial pulse has one.
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Venous pulse height varies with position and respiration, falling during inspiration.
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Abdominal compression raises the venous pulse.
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The venous pulse is not easily palpable and can be occluded with light pressure.