Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
PULSE & JVP : A QUICK REVISION
DR SUBHANKAR PAUL
Definitions
• Pulse : it is the expansion & elongation of the
arterial wall due to pressure imparted by the
column of bloo...
EXAMINATION OF PULSE
• RATE
• RHYTHM
• VOLUME
• CHARACTER
• CONDITION OF ARTERIAL WALL
• RADIO-RADIAL / RADIO –FEMORAL DEL...
RATE
RELATIVE TACHYCARDIA & RELATIVE
BRADYCARDIA : Related to TEMPARATURE
RELATIVE TACHYCARDIA
• Acute Rheumatic Carditis
• Dip...
RHYTHM
Regularly Irregular Rhythm
• Sinus Arrhythmia
• 2ND DEGREE av BLOCK
• Atrial tachyarrhythmias
(MAT and atrial flutt...
Pulse Deficit (Apex-Pulse Deficit)
It is the difference between the heart rate and
the pulse rate, when counted simultaneo...
Pulse Volume
• Volume is the movement imparted to your fingers and
reflects the pulse pressure - the difference between
sy...
Character
• Character is the impression of the pulse
waveform obtained
• best assessed in the carotid arteries except.
bis...
CATACROTIC PULSE : NORMAL PULSE
Hypokinetic Pulse
Small weak pulse
(small volume and
narrow pulse
pressure).
Anacrotic Pulse (Parvus et Tardus)
A low amplitude pulse (parvus) with a
slow rising and late peak (tardus).
Hyperkinetic Pulse
A high
amplitude
pulse with a
rapid rise
(large
volume
and wide
pulse
pressure).
Collapsing Pulse (Water-Hammer
Pulse, Corrigans Pulse)
It is a large volume pulse with a rapid upstroke
(systolic pressure...
METHOD OF EXAMINATION
Causes
Patent ductus arteriosus
Aortic regurgitation
Arteriovenous fistula
Rupture of sinus of Valsalva.
Thready pulse is ...
DOUBLE-BEATING PULSE
PULSUS BISFERIENCE
PULSUS DICROTICUS
Pulsus Bisferiens
best felt in brachial and femoral artery
due to ejection of rapid jet of
blood through the aortic
valve....
Pulsus Dicroticus
Mechanism :
due to a very low stroke
volume with decreased
peripheral resistance
It is a single pulse wa...
Pulsus Alternans
Causes
Left ventricular failure
Typhoid fever
Dehydration
Dilated cardiomyopathy
Cardiac tamponade
Pulsus Bigemini
• A pulse wave with a normal beat followed by a
premature beat and a compensatory pause,
occurring in rapi...
Pulsus paradoxus
It is an exaggerated reduction in the strength
of arterial pulse during normal inspiration or
an exaggera...
Reverse pulsus paradoxus
• is an inspiratory rise in arterial pressure.
• Causes
• Hypertrophic obstructive cardiomyopathy...
Condition of Arterial Wall
• Young adult : Not Palpable
• Old Individuals , Hypertensive patients :
Palpable
PERIPHERAL PULSES
Carotid pulse
SYMMETRY of the PERIPHERAL PULSES
RADIO-RADIAL & RADIO-FEMORAL
DELAY
• Particularly important for pediatric age group
• Delay of the femoral compared with t...
Radio-femoral Delay
CAUSES
RADIO-RADIAL delay
• PRE-SUBCLAVIAN COA
• THORACIC INLET
SYNDROME : CERVICAL RIB
• TAKAYASU’S DISEASE
• AORTIC ARCH...
Jugular Venous Pressure & Waveform
Definition
• Jugular Venous Pulse:
defined as the oscillating top of vertical
column of blood in right IJV that reflects t...
Why Internal Jugular Vein?
• IJV has a direct course to RA.
• IJV is anatomically closer to RA.
• IJV has no valves( Valve...
Why Right Internal Jugular Vein?
• Right jugular veins extend in an almost straight
line to superior vena cava, thus favou...
Method Of Examination
• The patient should be comfortable during the examination.
• Clothing should be removed from the ne...
• Identify the timing and waveform of the
pulsation and note any abnormality
• Estimate the vertical height in centimetres...
Observation
• (A) Supine: jugular vein distended, pulsation not
visible. (B) Reclining at 45°: point of transition between
distended a...
Difference from Carotid Pulse
JVP CAROTID PULSE
Better Visible Better Palpable
INSPECTION Oscillatory wavefom with Inward ...
Observations Made
• the level of venous pressure.
• the type of venous wave pattern.
The level of venous pressure
The level of venous pressure
• Using a centimeter ruler, measure the vertical
distance between the angle of Louis (manubri...
WHY The sternal angle is used as the
reference point ??
Upto Harrison's 17th edition
• “The sternal angle is used
as the r...
SO , WHAT THEY SUGGEST ????
• “The use of the clavicle may provide an easier
reference for standardization. Venous
pulsati...
Abdomino-jugular reflux
Upto Harrison's 17th edition
• “A positive
abdominojugular test is
best defined as an
increase in ...
Abdomino-jugular reflux
• Most common cause of a positive test is RHF/
(incipient Heart Failure )
• Positive test in: Borderline elevation of JVP
...
the type of venous wave pattern.
• Venous distension due to RA contraction
Retrograde blood flow into SVC and IJV
• Synchronous with S1, Follow P of ECG
• ...
• The x descent: is due to
X Atrial relaxation
X` Descent of the floor of the right atrium
during right ventricular systol...
v WAVE
• Rising right atrial pressure when blood flows into the
right atrium during ventricular systole when the
tricuspid...
y DESCENT
• The decline in right atrial pressure when the tricuspid valve
reopens
• Following the bottom of the y descent ...
Normal pattern of the jugular venous pulse
• The normal JVP reflects phasic pressure changes in
the right atrium and consi...
• Descents are better seen than positive waves.
Normally X descent is more prominent than Y descent.
• The a wave occurs j...
jugular venous pulse
• clinical corelates:
• Abnormalities in Pressure
• Abnormalities in Waveform
Abnormalities in jugular venous
Pressure
Causes of Elevated JVP
1. Unilateral non-pulsatile
 Innominate vein thrombosis
2. Bilateral non-pulsatile
 SVC obstructi...
Abnormalities in jugular venous
Waveform
Abnormalities in a wave
• Elevated “a” wave
• Cannon “a” wave
• Absent “a” wave
an increased delay between the a wave and ...
Elevated “a” wave
• Tricuspid stenosis
• Increased
Resistance to RV
Filling.
 PS
 PAH
Large a waves indicate that the ri...
Cannon “a” wave
IRREGULAR REGULAR
Junctional rhythm
Junctional tachycardia.Atrial-ventricular
Dissociation
(atria contract...
Absent “a” wave
• 1. Atrial fibrillation
Elevated “v” wave
1. Tricuspid regurgitation.
2. Right ventricular failure.
3. Restrictive cardiomyopathy.
4. Cor Pulmonale
“a” wave equal to “v” wave
ASD
Prominent X descent
followed by a large
V wave
M Configuration
Indicates a large L-R
shunt
...
1. Cardiac tamponade.
2. Constrictive Pericarditis
3. RVMI
4. Restrictive Cardiomyopathy
Prominent “x” descent
Obliteratio...
Prominent “y” descent
1. Constrictive pericarditis.
2. Tricuspid regurgitation.
1. Cardiac tamponade.
2. Right ventricular...
Tricuspid regurgitation
• Absent X Descent
• CV/ Regurgitant Wave
• Followed by a rapid deep
Y descent
• May cause subtle ...
Constrictive pericarditis.
• M shaped contour
• Prominent X and Y descent (FRIEDREICH`SIGN)
• Y descent is prominent as ve...
Kussmaul sign ( Venous Pulsus Paradoxus)
• Normally, the venous pressure should fall by at least
3 mmHg with inspiration
•...
Raised jugular venous pressure with shock
• Congestive Heart failure
• Cardiac tamponade
• Rt ventricular infarction
• Ten...
Recent Studies
• Although the JVP estimates right ventricular filling pressure, it
has a predictable relationship with the...
Pulse & JVP
Pulse & JVP
Pulse & JVP
Pulse & JVP
Pulse & JVP
Pulse & JVP
Pulse & JVP
Pulse & JVP
Pulse & JVP
Pulse & JVP
Upcoming SlideShare
Loading in …5
×

Pulse & JVP

14,155 views

Published on

A Quick revision on Pulse & JVP for Undergraduate Medical Students & Postgraduate

Published in: Healthcare
  • Login to see the comments

Pulse & JVP

  1. 1. PULSE & JVP : A QUICK REVISION DR SUBHANKAR PAUL
  2. 2. Definitions • Pulse : it is the expansion & elongation of the arterial wall due to pressure imparted by the column of blood during cardiac cycle • JVP oscillating top of vertical column of blood in right IJV that reflects the phasic pressure changes in Right Atrium in cardiac cycle
  3. 3. EXAMINATION OF PULSE • RATE • RHYTHM • VOLUME • CHARACTER • CONDITION OF ARTERIAL WALL • RADIO-RADIAL / RADIO –FEMORAL DELAY • PERIPHERAL PULSES
  4. 4. RATE
  5. 5. RELATIVE TACHYCARDIA & RELATIVE BRADYCARDIA : Related to TEMPARATURE RELATIVE TACHYCARDIA • Acute Rheumatic Carditis • Diphtheric myocarditis • Tuberculosis RELATIVE BRADYCARDIA • Any Viral fever ( Dengue, Yellow fever : Faget’s sign) • Enteric fever 1st week • Pyogenic Meningitis/ Intra cerebral Abscess • Brucellosis 1DEGREE F temp rise = increase in Pulse rate by 10/min
  6. 6. RHYTHM Regularly Irregular Rhythm • Sinus Arrhythmia • 2ND DEGREE av BLOCK • Atrial tachyarrhythmias (MAT and atrial flutter) with fixed AV block • Ventricular bigemini, trigemini. IRegularly Irregular Rhythm • Atrial fibrillation • Atrial or ventricular ectopics • Atrial tachyarrhythmias (MAT and atrial flutter) with varying AV blocks
  7. 7. Pulse Deficit (Apex-Pulse Deficit) It is the difference between the heart rate and the pulse rate, when counted simultaneously for one full minute. Method : single examiner / Double Examiner Interpretation : • More than 10per min : atrial Fibrillation • Pulse deficit Less than 10: MAT / VPC
  8. 8. Pulse Volume • Volume is the movement imparted to your fingers and reflects the pulse pressure - the difference between systolic and diastolic blood pressure • best assessed by palpating the carotid artery • When pulse pressure is between 30 and 60 mm Hg, pulse volume is normal. • When pulse pressure is less than 30 mm Hg, it is a small volume pulse. • When pulse pressure is greater than 60 mm Hg, it is a large volume pulse • Pulse volume depends on stroke volume and arterial compliance
  9. 9. Character • Character is the impression of the pulse waveform obtained • best assessed in the carotid arteries except. bisferiens pulse , pulsus alternans, are more evident in peripheral arteries
  10. 10. CATACROTIC PULSE : NORMAL PULSE
  11. 11. Hypokinetic Pulse Small weak pulse (small volume and narrow pulse pressure).
  12. 12. Anacrotic Pulse (Parvus et Tardus) A low amplitude pulse (parvus) with a slow rising and late peak (tardus).
  13. 13. Hyperkinetic Pulse A high amplitude pulse with a rapid rise (large volume and wide pulse pressure).
  14. 14. Collapsing Pulse (Water-Hammer Pulse, Corrigans Pulse) It is a large volume pulse with a rapid upstroke (systolic pressure is high) and a rapid downstroke (diastolic pressure is low). The rapid upstroke is because of an increased stroke volume. The rapid downstroke is because of diastolic run-off into the left ventricle, and decreased peripheral resistance and rapid run-off to the periphery. Decreased peripheral resistance is due to large stroke volume stretching carotid and aortic sinus leading to reflex decrease in peripheral resistance
  15. 15. METHOD OF EXAMINATION
  16. 16. Causes Patent ductus arteriosus Aortic regurgitation Arteriovenous fistula Rupture of sinus of Valsalva. Thready pulse is seen in shock. Jerky pulse is seen in HOCM.
  17. 17. DOUBLE-BEATING PULSE PULSUS BISFERIENCE PULSUS DICROTICUS
  18. 18. Pulsus Bisferiens best felt in brachial and femoral artery due to ejection of rapid jet of blood through the aortic valve. During the peak of flow, Bernouli’ s effect on the walls of ascending aorta causes a sudden decrease in lateral pressure on the inner aspect of the wall. Dissection of aorta (unilateral bisferiens). Pulsus bisferiens is a single pulse wave with two peaks in systole
  19. 19. Pulsus Dicroticus Mechanism : due to a very low stroke volume with decreased peripheral resistance It is a single pulse wave with one peak in systole and one peak in diastole
  20. 20. Pulsus Alternans Causes Left ventricular failure Typhoid fever Dehydration Dilated cardiomyopathy Cardiac tamponade
  21. 21. Pulsus Bigemini • A pulse wave with a normal beat followed by a premature beat and a compensatory pause, occurring in rapid succession, resulting in alternation of the strength of the pulse • In pulsus alternans, compensatory pause is absent, whereas in pulsus bigeminus, compensatory pause is present. • Pulsus bigeminus is a sign of digitalis toxicity.
  22. 22. Pulsus paradoxus It is an exaggerated reduction in the strength of arterial pulse during normal inspiration or an exaggerated inspiratory fall in systolic pressure of more than 10 mm Hg during quiet breathing. Pulsus paradoxus is best assessed by measuring the difference in systolic blood pressure during inspiration and expiration During deep inspiration Pulse may be absent
  23. 23. Reverse pulsus paradoxus • is an inspiratory rise in arterial pressure. • Causes • Hypertrophic obstructive cardiomyopathy • Intermittent positive pressure ventilation • Atrioventricular dissociation
  24. 24. Condition of Arterial Wall • Young adult : Not Palpable • Old Individuals , Hypertensive patients : Palpable
  25. 25. PERIPHERAL PULSES
  26. 26. Carotid pulse
  27. 27. SYMMETRY of the PERIPHERAL PULSES
  28. 28. RADIO-RADIAL & RADIO-FEMORAL DELAY • Particularly important for pediatric age group • Delay of the femoral compared with the right radial pulse is found in coarctation of the aorta Artery Time at which pulse wave arrives after cardiac systole Carotid 30 milliseconds Brachial 60 milliseconds Radial 80 milliseconds Femoral 75 milliseconds
  29. 29. Radio-femoral Delay
  30. 30. CAUSES RADIO-RADIAL delay • PRE-SUBCLAVIAN COA • THORACIC INLET SYNDROME : CERVICAL RIB • TAKAYASU’S DISEASE • AORTIC ARCH ANEURYSM RADIO-FEMORAL DELAY • COA • AORTOARTERITIS • ATHEROSCLEROSIS OF AORTA
  31. 31. Jugular Venous Pressure & Waveform
  32. 32. Definition • Jugular Venous Pulse: defined as the oscillating top of vertical column of blood in right IJV that reflects the phasic pressure changes in Right Atrium in cardiac cycle. • Jugular Venous Pressure: Vertical height of oscillating column of blood .
  33. 33. 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) • external jugular vein is more superficial & prone to kinking and partial obstruction as it traverses the deep fascia of the neck. • Vasoconstriction Secondary to hypotension ( in CCF) can make EJV small and barely visible.
  34. 34. 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.
  35. 35. Method Of Examination • The patient should be comfortable during the examination. • Clothing should be removed from the neck and upper thorax. There should not be any tight bands around abdomen • Patient reclining with head elevated 45 ° (When the patient reclines at 45° the upper limit of the JVP is at the level of the clavicle) Ensure that the neck muscles are relaxed by resting the back of the head on a pillow. Neck should not be sharply flexed & slightly rotated towards the opposite side • Examined effectively by shining a light tangentially across the neck from the right side of the patient • → Identify the internal jugular pulsation in between two heads of SCM , (DIFFERENTIATE it from CAROTID PULSATION)
  36. 36. • Identify the timing and waveform of the pulsation and note any abnormality • Estimate the vertical height in centimetres between the top of the venous pulsation and the sternal angle to give the venous pressure • If necessary, readjust the position of the patient until the waveform is clearly visible & if necessary use the abdominojugular reflux .
  37. 37. Observation
  38. 38. • (A) Supine: jugular vein distended, pulsation not visible. (B) Reclining at 45°: point of transition between distended and collapsed vein can usually be seen to pulsate just above the clavicle. (C) Upright: upper part of vein collapsed and transition point obscured WHY 45° ?? FOR BETTER VISUALISATION the pulsation of the internal jugular vein is greatest when the trunk is inclined by less than 30° : HARRISON’S 17TH
  39. 39. Difference from Carotid Pulse JVP CAROTID PULSE Better Visible Better Palpable INSPECTION Oscillatory wavefom with Inward movement more prominent Rapid outward jerky movement Two peaks per heartbeat (in sinus rhythm) One peak per heartbeat Seen in the triangle formed by the two heads of the sternomastoid and the clavicle Seen internal to sternomastoid Independent of respiration Height of pulsation varies with respiration (DECREASES in INSPIRATION) Independent of position Varies with position of patient PALPATION Pulsation unaffected by pressure at the root of the neck Pulsation diminished by pressure at the root of the neck Independent of abdominal pressure Rises with abdominal pressure
  40. 40. Observations Made • the level of venous pressure. • the type of venous wave pattern.
  41. 41. The level of venous pressure
  42. 42. The level of venous pressure • Using a centimeter ruler, measure the vertical distance between the angle of Louis (manubrio sternal joint) and the highest level of jugular vein pulsation. • Add 5 cm to measure central venous pressure since right atrium is 5 cm below the sternal angle. Normal CVP is < 7mm of Hg or 9 cm H2O (1.36 cmH2O = 1.0 mmHg) • The upper limit of normal is 4 cm above the sternal angle • A distance >4.5 cm at 30° elevation is considered abnormal
  43. 43. WHY The sternal angle is used as the reference point ?? Upto Harrison's 17th edition • “The sternal angle is used as the reference point because the center of the right atrium lies approximately 5 cm below the sternal angle in the average patient, regardless of body position” Harrison's 18th edition onwards • “the actual distance between the mid-right atrium and the angle of Louis varies considerably as a function of both body size and the patient angle at which the assessment is made (30°, 45°, or 60°). The use of the sternal angle as a reference point leads to systematic underestimation of CVP, and this method should be used less for semiquantification than to distinguish a normal from an abnormally elevated CVP”
  44. 44. SO , WHAT THEY SUGGEST ???? • “The use of the clavicle may provide an easier reference for standardization. Venous pulsations above this level in the sitting position are clearly abnormal, as the distance between the clavicle and the right atrium is at least 10 cm. The patient should always be placed in the sitting position, with the legs dangling below the bedside, when an elevated pressure is suspected in the semisupine position”
  45. 45. Abdomino-jugular reflux Upto Harrison's 17th edition • “A positive abdominojugular test is best defined as an increase in JVP during 10 s of firm midabdominal compression followed by a rapid drop in pressure of 4 cm blood on release of the compression” Harrison's 18th edition onwards • “The abdominojugular reflex is elicited with firm and consistent pressure over the upper portion of the abdomen, preferably over the right upper quadrant, for at least 10 s. A positive response is defined by a sustained rise of more than 3 cm in JVP for at least 15 s after release of the hand”
  46. 46. Abdomino-jugular reflux
  47. 47. • Most common cause of a positive test is RHF/ (incipient Heart Failure ) • Positive test in: Borderline elevation of JVP Silent TR Latent RHF • False Negative: SVC/IVC obstruction Budd Chiari syndrome • Positive Test imply SVC and IVC are patent
  48. 48. the type of venous wave pattern.
  49. 49. • Venous distension due to RA contraction Retrograde blood flow into SVC and IJV • Synchronous with S1, Follow P of ECG • Precede Carotid pulse a WAVE
  50. 50. • The x descent: is due to X Atrial relaxation X` Descent of the floor of the right atrium during right ventricular systole. Begins during systole and ends before S2 • The c wave: Occurs simultaneously with the carotid pulse Artifact by Carotid pulsation Bulging of TV into RA during ICP
  51. 51. v WAVE • Rising right atrial pressure when blood flows into the right atrium during ventricular systole when the tricuspid valve is shut. • Synchronous with Carotid pulse • Peaks after S2
  52. 52. y DESCENT • The decline in right atrial pressure when the tricuspid valve reopens • Following the bottom of the y descent and before beginning of the a wave is a period of relatively slow filling of the ventricle, the diastases period, a wave termed the h wave.
  53. 53. Normal pattern of the jugular venous pulse • The normal JVP reflects phasic pressure changes in the right atrium and consists of three positive waves and two negative troughs • Simultaneous palpation of the left carotid artery & auscultation of heart soounds at apex aids the examiner in relating the venous pulsations to the timing of the cardiac cycle.
  54. 54. • Descents are better seen than positive waves. Normally X descent is more prominent than Y descent. • The a wave occurs just before the first sound or carotid pulse. ‘c’ wave succeeds S1 or simultaneous with carotid pulse ( in fact • The c wave is never seen normally ) • The x descent occurs just prior to the second heart sound while the y descent occurs after the second heart sound • The v wave occurs just after the arterial pulse Identifying Wave Forms
  55. 55. jugular venous pulse • clinical corelates: • Abnormalities in Pressure • Abnormalities in Waveform
  56. 56. Abnormalities in jugular venous Pressure
  57. 57. Causes of Elevated JVP 1. Unilateral non-pulsatile  Innominate vein thrombosis 2. Bilateral non-pulsatile  SVC obstruction  Massive right sided pleural effusion 3. Bilateral pulsatile a. Cardiac  Cardiac failure  Tricuspid stenosis  Tricuspid regurgitation  Constrictive pericarditis  Cardiac tamponade b. Pulmonary : COPD/cor pulmonale c. Abdominal :  Ascites  Pregnancy d. Iatrogenic Excess IV fluids Low jugular venous pressure Hypovolaemia.
  58. 58. Abnormalities in jugular venous Waveform
  59. 59. Abnormalities in a wave • Elevated “a” wave • Cannon “a” wave • Absent “a” wave an increased delay between the a wave and the carotid arterial pulse in patients with first-degree atrioventricular block.
  60. 60. Elevated “a” wave • Tricuspid stenosis • Increased Resistance to RV Filling.  PS  PAH Large a waves indicate that the right atrium is contracting against an increased resistance
  61. 61. Cannon “a” wave IRREGULAR REGULAR Junctional rhythm Junctional tachycardia.Atrial-ventricular Dissociation (atria contract against a closed tricuspid valve) •Complete heart block •VPC •Ventricular tachycardia
  62. 62. Absent “a” wave • 1. Atrial fibrillation
  63. 63. Elevated “v” wave 1. Tricuspid regurgitation. 2. Right ventricular failure. 3. Restrictive cardiomyopathy. 4. Cor Pulmonale
  64. 64. “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
  65. 65. 1. Cardiac tamponade. 2. Constrictive Pericarditis 3. RVMI 4. Restrictive Cardiomyopathy Prominent “x” descent Obliteration of “x” descent 1. Tricuspid regurgitation.
  66. 66. Prominent “y” descent 1. Constrictive pericarditis. 2. Tricuspid regurgitation. 1. Cardiac tamponade. 2. Right ventricular infarction Absent “y” descent Slow “y” descent 1. Tricuspid stenosis. 2. Right atrial myxoma.
  67. 67. Tricuspid regurgitation • Absent X Descent • CV/ Regurgitant Wave • Followed by a rapid deep Y descent • May cause subtle motion of ear lobe with each heart beat
  68. 68. 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 Ventricular pressure curve exhibit Square Root sign.
  69. 69. Kussmaul sign ( Venous Pulsus Paradoxus) • Normally, the venous pressure should fall by at least 3 mmHg with inspiration • Kussmaul’s sign is defined by either a rise or a lack of fallof the JVP with inspiration CAUSE  Constrictive Pericarditis  Severe RHF and advanced left ventricular failure  Restrictive Cardiomyopathy  massive pulmonary embolism,  right ventricular infarction,
  70. 70. Raised jugular venous pressure with shock • Congestive Heart failure • Cardiac tamponade • Rt ventricular infarction • Tension pneumothorax • Massive pulmonary embolism
  71. 71. Recent Studies • Although the JVP estimates right ventricular filling pressure, it has a predictable relationship with the pulmonary artery wedge pressure. • In a large study of patients with advanced heart failure, the presence of a right atrial pressure >10 mmHg (as predicted on bedside examination) had a positive value of 88% for the prediction of a pulmonary artery wedge pressure of >22 mmHg. • In addition, an elevated JVP has prognostic significance in patients with both symptomatic heart failure and asymptomatic left ventricular systolic dysfunction. • The presence of an elevated JVP is associated with a higher risk of subsequent hospitalization for heart failure, death from heart failure, or both.

×