JVP's - Appearance and Interpretation
The JVP (jugular venous pressure) is a manometer of pressure in the right atrium; when pressure in the atrium
is high the JVP will be raised and when right atrial pressure is low the JVP will drop.
Features of the JVP
A venous pulse is not usually palpable.
Pressing at the base of the vein will make the vein visible as it continues to fill and distend above the point of
pressure NB do not do this in exams.
Hepatojugular reflex aids identfication of JVP - probably by forcing blood out of liver into IVC and therefore
into right atrium increasing its pressure.
JVP alters with changes in posture.
How to find the JVP
Sit patient at 45° and turn head slightly away from you.
Look for JVP in internal jugular vein (not external jugular vein) medial to the clavicular head of
sternocleidomastoid; the vein passes behind the angle of the jaw in direction of earlobe.
Measure JVP in cm above the sternal notch - a vertical not diagonal distance - if larger than 3cm the JVP is
The JVP Waveform
of height of JVP with time
Abnormalities of the JVP
1) Raised JVP with normal waveform
2) Raised JVP with absent pulsation
- right heart failure
- fluid overload
3) Large a wave
- SVC obstruction - full dilated jugular veins, no pulsation, oedematous face and neck
4) Extra-large a wave = Cannon wave
- tricuspid stenosis - atria contracts against stiff tricuspid and so pressure in atria rises higher than normal
- pulmonary hypertension - there are generally higher pressures on the right side of the heart
- pulmonary stenosis
Occurs when atrium contracts against closed tricuspid eg
ie any condition in which the atria and the ventricles are not conducting in appropriate rhythm
- complete heart block
- atrial flutter
- single chamber pacing
- nodal rhythm (AV node is in charge)
- ventricular extra-systole
- ventricular tachycardia
5) Absent a wave
6) Systolic waves = combined c-v waves = big v waves
7) The slow y descent occurs in tricuspid stenosis (if the HR is so low as to allow the length of descent to be
- tricuspid regurgitation (c-v wave because the pressure in the right atrium is raised throughout ventricular
systole - tip is to watch for earlobe movement!)
8) Paradoxical JVP = Kussmaul's sign
Normally the JVP should rise on expiration and fall on inspiration.
When the JVP rises on inspiration it indicates
- pericardial effusion
- constrictive pericarditis
- pericardial tamponade