The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.

1. Definition
• Jugular Venous Pulse:
defined as the oscillating top of vertical
column of blood in right IJV that reflects pressure
changes in Right Atrium in cardiac cycle.
• Jugular Venous Pressure:
Vertical height of oscillating column of blood.

2. Why Internal Jugular Vein?
• IJV has a direct course to RA.
• IJV is anatomically closer to RA.
• IJV has no valves( Valves in EJV prevent transmission
of RA pressure)
• Vasoconstriction Secondary to hypotension ( in
CCF) can make EJV small and barely visible.

3. Why Right Internal Jugular Vein?
• Right jugular veins extend in an almost straight line to
superior vena cava, thus favouring transmission of the
haemodynamic changes from the right atrium.
• The left innominate vein is not in a straight line and
may be kinked or compressed between Aortic Arch
and sternum, by a dilated aorta, or by an aneurysm.

5. Difference from Carotid Pulse
Venous PulseVenous Pulse Carotid PulseCarotid Pulse
More lateralMore lateral MedialMedial
Wavy, UndulantWavy, Undulant Forceful, BriskForceful, Brisk
Decrease with InspirationDecrease with Inspiration No changeNo change
Increase in supine positionIncrease in supine position No changeNo change
^with abdominal pressure^with abdominal pressure No changeNo change
Double PeakedDouble Peaked Single PeakSingle Peak
Obliterated with PressureObliterated with Pressure Cannot be ObliteratedCannot be Obliterated
Better VisibleBetter Visible Better palpatedBetter palpated
Better viewed from footBetter viewed from foot
end of bedend of bed

6. Method Of Examination
• The patient should lie comfortably during the examination.
• Clothing should be removed from the neck and upper thorax.
• Patient reclining with head elevated 45 °
• Neck should not be sharply flexed.
• Examined effectively by shining a light tangentially across the neck.
• There should not be any tight bands around abdomen

7. The Jugular Venous Pulse
 Method:
1. Subject performs Valsalva manoeuvre (deep
inspiration followed by forced expiration against
closed glottis), internal jugular vein will be
prominent.
2. Choose position on the IJV away from CA.
3. Place pulse transducer over the vein & keep it in
position with self adhesive plaster.
4. Connect to recorder.
7

8. 8
 Pressure changes in RA can be recorded
from IJV as there are no valves between
them.
The EJV can’t be relied because it:
1. has valves,
2. ? obstructed by facial & muscular layers through
which it passes.
 JVP ↑ in:
1. Rt. Sided heart failure.
2. Fluid overload.

9. Observations Made
• the level of venous pressure.
• the type of venous wave pattern.

10. Jugular venous pressure

12. Normal pattern of the jugular venous pulse

13. “a”
wave

15. “v” wave

16. “y” descent

19. Clinical abnormalities:
 ‘a’ wave:
• Prominent: 1. RV hypertrophy (↑ resist of filling)
2. Pulmonary stenosis.
3. Pulmonary hypertension.
4. Tricuspid stenosis.
• Absence: Atrial fibrillation, TR.
• Cannon wave: Complete AV block, atrial flutter,
ventricular extrasystole.
 ‘c’ wave: Prominent in TR; absent in const.peric.
‘v’ wave: Prominent in constrictive pericarditis.

22. Abnormalities of jugular venous
pulse
A. Low jugular venous pressure
1. Hypovolaemia.

23. B. Elevated jugular venous
pressure
1. Intravascular volume overload conditions
Right ventricular infarction
Left heart failure
Myocardial infarction.
Valvular Heart Disease
Cardiomyopathy
2. Constrictive pericarditis.
3. Pericardial effusion with tamponade

24. Elevated “a” wave
Increased Resistance to
RV Filling.
Tricuspid stenosis
R Heart Failure
PS
PAH

25. Cannon “a” wave
• Atrial-ventricular
Dissociation
(atria contract against
a closed tricuspid
valve)
Complete heart block
VPC
Ventricular
tachycardia
Ventricular pacing
Junctional rhythm
Junctional
tachycardia.

26. Absent “a” wave
• 1. Atrial fibrillation

27. Elevated “v” wave
1. Tricuspid regurgitation.
2. Right ventricular failure.
3. Restrictive cardiomyopathy.
4. Cor Pulmonale

28. Tricuspid regurgitation
• Absent X Decsent
• CV/ Regurgitant Wave
• Has a rounded contour
and a sustained peak
• Followed by a rapid deep
Y descent
• Amplitude of V increases
with inspiration.
• Cause subtle motion of
ear lobe with each heart
beat

29. “a” wave equal to “v” wave
ASD
Prominent X descent
followed by a large V
wave
M Configuration
Indicates a large L-R shunt
With PAH A wave
becomes more
prominent
If L JVP > R JVP indicates
associated PAPVC

30. Prominent “x” descent
1. Cardiac tamponade.
2. Constrictive Pericarditis
3. RVMI
4. Restrictive Cardiomyopathy
5. Atrial septal defect
Blunted “x” descent
1. Tricuspid regurgitation.
2. Right atrial ischaemia

31. Prominent “y” descent
1. Constrictive pericarditis.
2. Tricuspid regurgitation.
3. Atrial septal defect.
1. Cardiac tamponade.
2. Right ventricular infarction
3. Restrictive Cardiomyopathy
Absent “y” descent
Slow “y” descent
1. Tricuspid stenosis.
2. Right atrial myxoma.

32. Constrictive pericarditis.
• M shaped contour
• Prominent X and Y descent (FRIEDREICH`SIGN)
• Y descent is prominent as ventricular filling is
unimpeded during early diastole.
• This is interrupted by a rapid raise in pressure as the
filling is impeded by constricting Pericardium
• The Ventriclar pressure curve exhibit Square Root sign

34. Abdomino-jugular reflux
• Is positive when JVP increase after 10 sec of abdominal pressure
followed by a rapid drop in pressure of 4 cm on release of
compression.
• Most common cause of a positive test is RHF
• Positive test in: Borderline elevation of JVP
Silent TR
Latent RHF
• False positive: Fluid overload
• False Negative: SVC/IVC obstruction
Budd Chiari syndrome
• Positive Test imply SVC and IVC are patent

35. Kussmaul sign
Failure of decline in JVP occur during inspiration.
• Constrictive Pericarditis
• Severe RHF
• Restrictive Cardiomyopathy
• Tricuspid Stenosis