Paediatrics or in a new born child, checking of jugular venous pressure. Definition, causes, abnormalities and difference between jugular and carotid pulse. We have discussed total of five topics :
- Definition ofJVP
- Characteristics of JVP
- Causes of elevated JVP
- Abnormalities of JVP
- Difference between carotid and jugular venous pulse
I. Jugular venous pressure :
The jugular venous pressure (JVP, also known as jugular venous pulse) is the pressure over the venous system that is indirectly measured by visualising the internal jugular vein. It can help distinguish between different types of heart and lung illness.
Underneath the sternomastoid muscle is the internal jugular vein.
II. Characteristics of Jugular venous pressure :
- Tends to vary with posture
- Keeps varying with respiration
- Hepatojugular reflex causes a temporary rise in volume and height
- Presents with double waveform
- Pressure at the waveform’s base obliterates it
III. Causes of elevated Jugular venous pressure :
There are several causes of increasing JVP, and they are :
- Pulmonary embolism
- Cardiac tamponade
- Tricuspid valve disease
- Superior vena cava obstruction
- Congestive heart failure
- Cor pulmonale
- Iatrogenic fluid overload like in surgical and renal patient
- Constrictive pericarditis
- Hypertrophic/restrictive cardiomyopathy
IV. Abnormalities of Jugular venous pressure :
We have discussed total of nine abnormalities of JVP, and they are described below :
1. Heart failure :
Heart failure, sometimes called congestive heart failure, happens when your heart muscle fails to pump blood as efficiently as it should. Certain disorders, such as restricted arteries in the heart (coronary artery disease) or high blood pressure, gradually weaken or stiffen your heart, making it difficult to fill and pump blood properly.
- There will be elevation of JVP
- And the sustained abdominojugular reflux > 10 seconds
2. Complete heart block :
When an electrical signal cannot travel normally from the atria, the heart’s upper chambers, to the ventricles, or lower chambers, complete heart block develops. Complete heart block can occur if the atrioventricular (AV) node is injured during surgery. Complete heart block can occur without surgery in some cases.
- The waves looks like ‘Cannon’
3. Tricuspid stenosis :
Tricuspid valve stenosis, also called tricuspid stenosis, is a narrowing of the tricuspid valve of the heart. The tricuspid valve is located between the right atrium (upper chamber of the heart) and the right ventricle (lower chamber of the heart), and it prevents blood flow from the right ventricle from returning into the right atrium.
- Giant ‘a’ waves
4. Tricuspid regurgitation :
The valve between the two right heart chambers (right ventricle and right atrium) does not seal properly in tricuspid valve regurgitation. The faulty valve permits blood to flow back into the upper right chamber of your heart (right atrium).
- Giant ‘v’ waves
5. Pericardial effusion :
A pericardial effusion is a collection of excess fluid surrounding the heart. If there is too much fluid in the body, it can put strain on the heart. It may be unable to pump normally as a result of this. The pericardium is a fibrous sac that surrounds the heart. There are two thin layers to this sac.
- Elevation of JVP
- Prominent ‘y’ descent
6. Superior vena cava obstruction :
A constriction or blockage of the superior vena cava (SVC), the body’s second biggest vein, is known as SVC obstruction. The superior vena cava is a vein that transports blood from the upper body to the heart.
- Elevation of JVP
- Sustained abdominojugular reflux > 10 seconds
7. Atrial fibrillation :
When the two top chambers of your heart receive chaotic electrical signals, atrial fibrillation occurs, resulting in an irregular and often fast heart rate. As a result, the heart beats quickly and irregularly. In atrial fibrillation, the heart rate can range from 100 to 175 beats per minute.
- There may be absent of ‘a’ waves
8. Pericardial constriction :
The pericardium is inflamed for a long time, or chronically, in constrictive pericarditis. The heart is surrounded by a sac-like membrane called the pericardium. Scarring, thickening, and muscular tightening, or contracture, are all symptoms of inflammation in this area of the heart.
- Elevation of JVP
- Kussmaul’s sign
9. Pulmonary embolism :
A pulmonary embolism is a blockage in one of your lungs’ pulmonary arteries. Blood clots from deep veins in the legs or, in rare situations, veins in other parts of the body, migrate to the lungs and cause pulmonary embolism (deep vein thrombosis)
- Elevation of JVP
V. Difference between carotid and jugular pulsation :
|Topic||Carotid pulsation||Jugular venous pulsation|
|1. Movement types||1. Rapid outward movement||1. Rapid inward movement|
|2. Palpation||2. This is palpable||2. This is not palpable|
|3. Respiratory dependency||3. Does not depend on respiration||3. Pulsation height changes with respiration.|
|4. Abdominal pressure||4. Depends upon abdominal pressure||4. Rises with abdominal pressure|
|5. Position dependency||5. Does not depends upon the position |
|5. This keeps carrying with with position|
|6. Peaks count||6. Occurrence of one peak per heart beat.||6. Occurrence of two peaks per heart beat|
in sinus rhythm.
|7. Pressure effect||7. Pulsation remains unaffected by |
pressure at the root of the neck.
|7. Pulsations starts to diminish by pressure|
at the root of the neck.