Jugular venous pressure

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.

Classically three upward deflections and two downward deflections have been described.

The upward deflections are the "a" (atrial contraction), "c" (ventricular contraction and resulting bulging of tricuspid into the right atrium during isovolumetric systole) and "v" (venous filling).

The downward deflections of the wave are the "x" descent (the atrium relaxes and the tricuspid valve moves downward) and the "y" descent (filling of ventricle after tricuspid opening).

Method

Visualization

The patient is positioned at a 45° incline. The head is gently turned to the left, and the right external jugular vein should be identified which may be pulsatile and the filling level noted. If the external jugular vein is pulsatile it is a reliable indicator of jugular venous pressure, however if it is not pulsatile it may contain a valve or be kinked, in which case it will not provide an accurate measure of jugular venous pressure. The JVP represents right atrial pressure, which in a healthy person should be between 2 – 8 cm

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. The JVP is measured from the level of the right atrium, however as it is impractical to determine the level of the right atrium, the position of the sternal angle is used as a surrogate, which is assumed to be 4 cm above the level of the right atrium.