Definition of "Jugular venous pressure"
Jugular venous pressure (JVP) is the indirectly observed pressure, over the venous system, as observed over the internal jugular vein. JVPNE/JVPNR is shorthand for JVP not elevated/raised.
Patient information
What is JVP. And what do doctors mean when they say it's elevated?JVP refers to the venous pressure of the internal jugular vein.
What is venous pressure, and what is the internal jugular vein?
Venous pressure just means the pressure of a vein. Rather than... an artery 
! So it's the blood pressure, particularly, at the internal jugular vein. That vessel colects blood from the brain. The key thing though, is that it drains down into the part of the heart that receives blood from the body, down the brachiocephalic vein, at the superior vena cava. This means that if the pressure in the right atrium (where blood enters the heart) is sufficiently high, it can flow back into the internal jugular, and be seen as a pulsation.
Source: Teach me anatomy
- Pt is positioned under 30 degrees
- Looking ALONG the surface of the sternocleidomastoid muscle, as it is more easier to appreciate the movement relative to the neck, when looking from the side (cf looking at the surface at a 90 degree angle):
- To determine the filling level of the external jugular vein. In healthy Pt's, the filling level of the JVP should be <3cm vertical height above the sternal angle. A pen-light can aid in discerning the jugular filling level, by providing tangential light
- Visualize the internal jugular vein, when looking for the pulsation
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Patient information
You look along the surface of the sternocleidomastoid muscle. What is this?It is a superficial muscle found on both sides of the neck, used to rotate the head to the opposite side, and to flex (reduce the angle of) the neck.
The filling angle of the JVP, should be <3cm vertical height above the sternal angle. What is the sternal angle?
It's the angle formed by the junction of the upper manubrium, and the rest of the sternum/breastbone. We use it because it's a landmark you can feel.
And the 3cm you measure using a ruler against the skin up to where you see the beat?
No! You don't measure the hypotenuse. You measure the VERTICAL distance, that you make with a right angle. And if it's higher than 3cm, it's a concern.
- Differentiate between different forms of heart and lung disease
- Specifically, JVP can be elevated/raised in high venous pressure, and indicates:
- R ventricular heart failure
- Tricuspid stenosis
- Tricuspid regurgitation
- Cardiac tamponade
- Fluid overload
- Artifically raised by applying pressure to the liver (hepatojugular reflex), used to differentiate it from the carotid pulse. Also, unlike the carotid pulse, the JVP is not palpable
- Classically, 3 upward deflections and 2 downward deflections have been described, including:
- Upward deflections of the wave, including:
- a, atrial contraction
- c, ventricular contraction, and resulting bulging of tricuspid into the R atrium during isovolumetric systole
- v, atrial venous filling
- Downward deflections of the wave, including:
- x, the atrium relaxes and the tricuspid valve moves downward
- y, filling of the ventricle after tricuspid opening
- Upward deflections of the wave, including:
- Central venous pressure
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