Simple JVP

What is Simple JVP?: A new method for assessing the jugular venous pressure (i.e., sitting and qualitative) that has been simplified for ease of use in clinical practice. Conventional methods are complicated (e.g., measuring the vertical distance from the sternal angle to the pulsating superior border of the right internal jugular vein in a 45-degree upright position).
Why use the right internal jugular vein?: Because of its anatomical location in line with the right atrium (see figure below). The external jugular vein has an effective antireflux valve, so the internal jugular vein is recommended for assessing the right atrial pressure (except in cases of its clear pulsation or Kussmaul's sign).
Is the jugular vein an index of right heart failure?: It is also an index of left heart failure. In many cases of left heart failure, the right atrial pressure and pulmonary artery wedge pressure are related (see related article). One mechanism underlying this association is Bernheim's effect, in which left ventricular pressure is transmitted across the interventricular septum to the right ventricle.
Why is the jugular vein depressed?: Because it reflects the x-descent (dilatation of the right atrium) and y-descent (opening of the tricuspid valve) (see figure below). If the right atrial pressure rises markedly, the v-wave during venous return increases and the vein becomes elevated. On the other hand, the carotid pulse is always arising.
Why is physical stress necessary?: To avoid missing mild to moderate increases in right atrial pressure. Severe elevation of right atrial pressure (e.g., >15 cmH₂O or >10 mmHg) is required to demonstrate a clear internal jugular venous pulsation in the seated position.
Who developed this application?: Tatsuya Kawasaki, MD, PhD (Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan). All rights reserved. No part of this application may be reproduced or sold in any form without permission. Click here to send an email to the developer.
What is the disclaimer?: As the interpretation of the jugular vein varies and is not absolute, no legal responsibility can be accepted for any action taken based on the information in this application and any damage or loss incurred as a result of such action.