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! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align=center| {{fontcolor|#2B3B44|Jugular venous distention Resident Survival Guide Microchapters}} | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Jugular venous distention resident survival guide#Overview|Overview]] | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Jugular venous distention resident survival guide#Causes|Causes]] | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Jugular venous distention resident survival guide#Diagnosis|Diagnosis]] | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Jugular venous distention resident survival guide#Treatment|Treatment]] | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Jugular venous distention resident survival guide#Do's|Do's]] | |||
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | [[Jugular venous distention resident survival guide#Don'ts|Don'ts]] | |||
|} | |||
__NOTOC__ | __NOTOC__ | ||
{{WikiDoc CMG}}; {{AE}} | {{WikiDoc CMG}}; {{AE}} {{Mitra}} {{MC}} | ||
{{SK}} Approach to Jugular venous distension, JVD workup, Approach to JVD, Approach to elevated jugular vein pressure, Elevated JVP algorithm, Elevated JVP workup | |||
==Overview== | ==Overview== | ||
Jugular | Jugular venous pressure (JVP) is considered the most useful finding for assessing the ventricular filling pressures and central venous pressure (CVP) at the bedside. | ||
The jugular venous pressure is measured as the vertical distance between the top of venous pulsation and the angle of Louise, i.e., where the manubrium meets the body of the sternum. A distance of >3cm is considered jugular venous distension (JVD) or an elevated jugular venous pressure (JVP). | |||
==Causes== | ==Causes== | ||
===Life Threatening Causes=== | ===Life Threatening Causes=== | ||
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. | Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. <ref name="pmid29885957">{{cite journal| author=Thibodeau JT, Drazner MH| title=The Role of the Clinical Examination in Patients With Heart Failure. | journal=JACC Heart Fail | year= 2018 | volume= 6 | issue= 7 | pages= 543-551 | pmid=29885957 | doi=10.1016/j.jchf.2018.04.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29885957 }} </ref> | ||
* [[Acute heart failure]] | *[[Acute heart failure]] | ||
* [[Massive pulmonary emboli]] | *[[Cardiac Tamponade]] | ||
* [[Right ventricular myocardial infarction | *[[Massive pulmonary emboli]] | ||
*[[Right ventricular myocardial infarction]] | |||
* [[Tension Pneumothorax]] | *[[Tension Pneumothorax]] | ||
===Common Causes=== | ===Common Causes=== | ||
* [[Congestive heart failure]] | Common causes of jugular venous distension include: <ref name="pmid22041729">{{cite journal| author=Jolobe OM| title=Disproportionate elevation of jugular venous pressure in pleural effusion. | journal=Br J Hosp Med (Lond) | year= 2011 | volume= 72 | issue= 10 | pages= 582-5 | pmid=22041729 | doi=10.12968/hmed.2011.72.10.582 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22041729 }} </ref> <ref name="pmid9665212">{{cite journal| author=McGee SR| title=Physical examination of venous pressure: a critical review. | journal=Am Heart J | year= 1998 | volume= 136 | issue= 1 | pages= 10-8 | pmid=9665212 | doi=10.1016/s0002-8703(98)70175-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9665212 }} </ref> | ||
* [[Cor pulmonale]] | *[[Congestive heart failure]] | ||
* [[Fluid overload]] | *[[Cardiomyopathy]] | ||
*[[Cor pulmonale]] | |||
*[[Constrictive pericarditis]] | |||
*[[Chronic obstructive pulmonary disease|Chronic obstructive pulmonary disease (copd)]] | |||
*[[Fluid overload]] | |||
*[[Pulmonary embolism]] | |||
*[[Pulmonary hypertension]] | |||
*[[Pulmonary valve stenosis]] | |||
*[[Restrictive cardiomyopathy]] | |||
*[[Right atrial myxoma]] | |||
*[[Right heart failure]] | |||
*[[Right ventricular myocardial infarction]] | |||
*[[Tension pneumothorax]] | |||
==Diagnosis== | ==Diagnosis== | ||
Shown below is an algorithm summarizing the diagnosis of jugular venous distension | Shown below is an algorithm summarizing the diagnosis of jugular venous distension. <ref name="pmid8409071">{{cite journal| author=Butman SM, Ewy GA, Standen JR, Kern KB, Hahn E| title=Bedside cardiovascular examination in patients with severe chronic heart failure: importance of rest or inducible jugular venous distension. | journal=J Am Coll Cardiol | year= 1993 | volume= 22 | issue= 4 | pages= 968-74 | pmid=8409071 | doi=10.1016/0735-1097(93)90405-p | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8409071 }} </ref> <ref name="pmid17943049">{{cite journal| author=Devine PJ, Sullenberger LE, Bellin DA, Atwood JE| title=Jugular venous pulse: window into the right heart. | journal=South Med J | year= 2007 | volume= 100 | issue= 10 | pages= 1022-7; quiz 1004 | pmid=17943049 | doi=10.1097/SMJ.0b013e318073c89c | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17943049 }} </ref> <ref name="pmid9665212">{{cite journal| author=McGee SR| title=Physical examination of venous pressure: a critical review. | journal=Am Heart J | year= 1998 | volume= 136 | issue= 1 | pages= 10-8 | pmid=9665212 | doi=10.1016/s0002-8703(98)70175-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9665212 }} </ref> <ref name="pmid6638720">{{cite journal| author=Dell'Italia LJ, Starling MR, O'Rourke RA| title=Physical examination for exclusion of hemodynamically important right ventricular infarction. | journal=Ann Intern Med | year= 1983 | volume= 99 | issue= 5 | pages= 608-11 | pmid=6638720 | doi=10.7326/0003-4819-99-5-608 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6638720 }} </ref> | ||
{{familytree/start |summary=JVD diagnosis Algorithm.}} | {{familytree/start |summary=JVD diagnosis Algorithm.}} | ||
| Line 41: | Line 69: | ||
:❑ [[Cor pulmonale]] (Massive [[pulmonary emboli]], [[COPD]]) | :❑ [[Cor pulmonale]] (Massive [[pulmonary emboli]], [[COPD]]) | ||
:❑ [[Pulmonary Hypertension]] | :❑ [[Pulmonary Hypertension]] | ||
:❑ [[Pulmonary valve stenosis]] | |||
:❑ [[Constrictive pericarditis]] | :❑ [[Constrictive pericarditis]] | ||
:❑ [[Cardiac Tamponade]] | :❑ [[Cardiac Tamponade]] | ||
| Line 49: | Line 78: | ||
❑ '''Fluid overload due to renal diseases''' | ❑ '''Fluid overload due to renal diseases''' | ||
❑ '''Tricuspid valve incompetence''' | ❑ '''Tricuspid valve incompetence''' | ||
❑ '''Tricuspid valve stenosis or obstruction'''|D02=<div style="float: Center; text-align: Center; width:20em; padding:1em;"> | ❑ '''Tricuspid valve stenosis or obstruction'''|D02=<div style="float: Center; text-align: Center; width:20em; padding:1em;"> | ||
❑ '''Superior vena cava obstrcution'''|D03=<div style="float: Center; text-align: Center; width:20em; padding:1em;"> | ❑ '''Superior vena cava obstrcution'''|D03=<div style="float: Center; text-align: Center; width:20em; padding:1em;"> | ||
❑ '''[[Positive pressure ventilation]]''' | ❑ '''[[Positive pressure ventilation]]''' | ||
❑ '''A large [[pleural effusion]]''' | ❑ '''A large [[pleural effusion]]''' | ||
❑'''[[Tension Pneumothorax]]'''}} | ❑'''[[Tension Pneumothorax]]'''}} | ||
| Line 60: | Line 94: | ||
==Treatment== | ==Treatment== | ||
The management of jugular venous distension should be directed towards the underlying causes. | *The management of jugular venous distension should be directed towards the underlying causes. <ref name="pmid28461007">{{cite journal| author=Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM | display-authors=etal| title=2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. | journal=J Am Coll Cardiol | year= 2017 | volume= 70 | issue= 6 | pages= 776-803 | pmid=28461007 | doi=10.1016/j.jacc.2017.04.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28461007 }} </ref> <ref name="pmid23256914">{{cite journal| author=O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA | display-authors=etal| title=2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 4 | pages= e78-e140 | pmid=23256914 | doi=10.1016/j.jacc.2012.11.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23256914 }} </ref> <ref name="pmid20696690">{{cite journal| author=MacDuff A, Arnold A, Harvey J, BTS Pleural Disease Guideline Group| title=Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. | journal=Thorax | year= 2010 | volume= 65 Suppl 2 | issue= | pages= ii18-31 | pmid=20696690 | doi=10.1136/thx.2010.136986 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20696690 }} </ref> <ref name="pmid25173341">{{cite journal| author=Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N | display-authors=etal| title=2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. | journal=Eur Heart J | year= 2014 | volume= 35 | issue= 43 | pages= 3033-69, 3069a-3069k | pmid=25173341 | doi=10.1093/eurheartj/ehu283 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25173341 }} </ref> | ||
*Treatment of [[congestive heart failure]] usually includes [[diuretics]] (for symptom relief), [[beta blockers]], [[angiotensin converting enzyme inhibitors]] ([[ACE-I]]) /[[aldosterone receptor blockers]] ([[ARB]]). | |||
**For a complete guide on the treatment of congestive heart failure, [[Heart failure resident survival guide|click here]].<br /> | |||
*Treatment of [[right ventricular myocardial infarction]] includes [[reperfusion]], maintenance of right ventricular [[preload]], decreasing right ventricular [[afterload]], restoring cardiac rate/rhythm and [[atrioventricular synchrony]], and inotropic support. | |||
**For a complete guide on the treatment of right ventricular myocardial infarction, [[Right ventricular myocardial infarction resident survival guide|click here]].<br /> | |||
*Treatment of massive [[pulmonary embolism]] usually includes [[fibrinolytic therapy]]. | |||
**For a complete guide on the treatment of pulmonary embolism, [[Pulmonary embolism resident survival guide|click here]].<br /> | |||
*Treatment of [[pericardial tamponade]] usually includes [[pericardiocentesis]]. | |||
**For a complete guide on the treatment of cardiac tamponade, [[Cardiac tamponade resident survival guide|click here]].<br /> | |||
*Treatment of [[tension pneumothorax]] includes immediate [[needle decompression]] followed by [[chest tube]] insertion. | |||
**For a complete guide on the treatment of tension pnemuothorax, [[Tension pneumothorax resident survival guide|click here]].<br /> | |||
==Do's== | ==Do's== | ||
* If the JVP does not seem elevated when the patient is supine, a provocative test, i.e., abdominojugular test, | * If the [[JVP]] does not seem elevated when the patient is supine, a provocative test, i.e., [[abdominojugular test]], might be performed. <ref name="pmid6650420">{{cite journal| author=Ducas J, Magder S, McGregor M| title=Validity of the hepatojugular reflux as a clinical test for congestive heart failure. | journal=Am J Cardiol | year= 1983 | volume= 52 | issue= 10 | pages= 1299-303 | pmid=6650420 | doi=10.1016/0002-9149(83)90592-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6650420 }} </ref> By increasing venous return and pressure, the [[abdominojugular test]], also known as [[hepatojugular reflux test]], helps in better assessment of jugular venous pulsations. | ||
==Don'ts== | ==Don'ts== | ||
* JVD only provides clues to the presence of an elevated CVP. Clinicians should avoid making decisions about the degrees of CVP elevation based on the JVP measurement. | * [[JVD]] only provides clues to the presence of an elevated [[central venous pressure]] ([[CVP]]). <ref name="pmid9665212">{{cite journal| author=McGee SR| title=Physical examination of venous pressure: a critical review. | journal=Am Heart J | year= 1998 | volume= 136 | issue= 1 | pages= 10-8 | pmid=9665212 | doi=10.1016/s0002-8703(98)70175-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9665212 }} </ref> | ||
* Clinicians should avoid making decisions about the degrees of [[CVP]] elevation based on the [[JVP]] measurement. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Resident survival guide]] | [[Category:Resident survival guide]] | ||
[[Category: | [[Category:Cardiology]] | ||
[[Category:Up-To-Date]] | |||
Latest revision as of 13:09, 4 November 2020
| Jugular venous distention Resident Survival Guide Microchapters |
|---|
| Overview |
| Causes |
| Diagnosis |
| Treatment |
| Do's |
| Don'ts |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mitra Chitsazan, M.D.[2] Mandana Chitsazan, M.D. [3]
Synonyms and keywords: Approach to Jugular venous distension, JVD workup, Approach to JVD, Approach to elevated jugular vein pressure, Elevated JVP algorithm, Elevated JVP workup
Overview
Jugular venous pressure (JVP) is considered the most useful finding for assessing the ventricular filling pressures and central venous pressure (CVP) at the bedside. The jugular venous pressure is measured as the vertical distance between the top of venous pulsation and the angle of Louise, i.e., where the manubrium meets the body of the sternum. A distance of >3cm is considered jugular venous distension (JVD) or an elevated jugular venous pressure (JVP).
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. [1]
- Acute heart failure
- Cardiac Tamponade
- Massive pulmonary emboli
- Right ventricular myocardial infarction
- Tension Pneumothorax
Common Causes
Common causes of jugular venous distension include: [2] [3]
- Congestive heart failure
- Cardiomyopathy
- Cor pulmonale
- Constrictive pericarditis
- Chronic obstructive pulmonary disease (copd)
- Fluid overload
- Pulmonary embolism
- Pulmonary hypertension
- Pulmonary valve stenosis
- Restrictive cardiomyopathy
- Right atrial myxoma
- Right heart failure
- Right ventricular myocardial infarction
- Tension pneumothorax
Diagnosis
Shown below is an algorithm summarizing the diagnosis of jugular venous distension. [4] [5] [3] [6]
With pulmonary edema | Without pulmonary edema | ||||||||||||||||||||||||||||||
Increased right atrial pressure | Venous obstruction | Increased intrathoracic pressure | |||||||||||||||||||||||||||||
❑ Restriction of right atrial and right ventricular filling:
❑RV Failure: ❑ Fluid overload due to renal diseases ❑ Tricuspid valve incompetence ❑ Tricuspid valve stenosis or obstruction |
❑ Superior vena cava obstrcution | ||||||||||||||||||||||||||||||
Treatment
- The management of jugular venous distension should be directed towards the underlying causes. [7] [8] [9] [10]
- Treatment of congestive heart failure usually includes diuretics (for symptom relief), beta blockers, angiotensin converting enzyme inhibitors (ACE-I) /aldosterone receptor blockers (ARB).
- For a complete guide on the treatment of congestive heart failure, click here.
- For a complete guide on the treatment of congestive heart failure, click here.
- Treatment of right ventricular myocardial infarction includes reperfusion, maintenance of right ventricular preload, decreasing right ventricular afterload, restoring cardiac rate/rhythm and atrioventricular synchrony, and inotropic support.
- For a complete guide on the treatment of right ventricular myocardial infarction, click here.
- For a complete guide on the treatment of right ventricular myocardial infarction, click here.
- Treatment of massive pulmonary embolism usually includes fibrinolytic therapy.
- For a complete guide on the treatment of pulmonary embolism, click here.
- For a complete guide on the treatment of pulmonary embolism, click here.
- Treatment of pericardial tamponade usually includes pericardiocentesis.
- For a complete guide on the treatment of cardiac tamponade, click here.
- For a complete guide on the treatment of cardiac tamponade, click here.
- Treatment of tension pneumothorax includes immediate needle decompression followed by chest tube insertion.
- For a complete guide on the treatment of tension pnemuothorax, click here.
- For a complete guide on the treatment of tension pnemuothorax, click here.
Do's
- If the JVP does not seem elevated when the patient is supine, a provocative test, i.e., abdominojugular test, might be performed. [11] By increasing venous return and pressure, the abdominojugular test, also known as hepatojugular reflux test, helps in better assessment of jugular venous pulsations.
Don'ts
- JVD only provides clues to the presence of an elevated central venous pressure (CVP). [3]
- Clinicians should avoid making decisions about the degrees of CVP elevation based on the JVP measurement.
References
- ↑ Thibodeau JT, Drazner MH (2018). "The Role of the Clinical Examination in Patients With Heart Failure". JACC Heart Fail. 6 (7): 543–551. doi:10.1016/j.jchf.2018.04.005. PMID 29885957.
- ↑ Jolobe OM (2011). "Disproportionate elevation of jugular venous pressure in pleural effusion". Br J Hosp Med (Lond). 72 (10): 582–5. doi:10.12968/hmed.2011.72.10.582. PMID 22041729.
- ↑ 3.0 3.1 3.2 McGee SR (1998). "Physical examination of venous pressure: a critical review". Am Heart J. 136 (1): 10–8. doi:10.1016/s0002-8703(98)70175-9. PMID 9665212.
- ↑ Butman SM, Ewy GA, Standen JR, Kern KB, Hahn E (1993). "Bedside cardiovascular examination in patients with severe chronic heart failure: importance of rest or inducible jugular venous distension". J Am Coll Cardiol. 22 (4): 968–74. doi:10.1016/0735-1097(93)90405-p. PMID 8409071.
- ↑ Devine PJ, Sullenberger LE, Bellin DA, Atwood JE (2007). "Jugular venous pulse: window into the right heart". South Med J. 100 (10): 1022–7, quiz 1004. doi:10.1097/SMJ.0b013e318073c89c. PMID 17943049.
- ↑ Dell'Italia LJ, Starling MR, O'Rourke RA (1983). "Physical examination for exclusion of hemodynamically important right ventricular infarction". Ann Intern Med. 99 (5): 608–11. doi:10.7326/0003-4819-99-5-608. PMID 6638720.
- ↑ Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM; et al. (2017). "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America". J Am Coll Cardiol. 70 (6): 776–803. doi:10.1016/j.jacc.2017.04.025. PMID 28461007.
- ↑ O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA; et al. (2013). "2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 61 (4): e78–e140. doi:10.1016/j.jacc.2012.11.019. PMID 23256914.
- ↑ MacDuff A, Arnold A, Harvey J, BTS Pleural Disease Guideline Group (2010). "Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010". Thorax. 65 Suppl 2: ii18–31. doi:10.1136/thx.2010.136986. PMID 20696690.
- ↑ Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N; et al. (2014). "2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism". Eur Heart J. 35 (43): 3033–69, 3069a–3069k. doi:10.1093/eurheartj/ehu283. PMID 25173341.
- ↑ Ducas J, Magder S, McGregor M (1983). "Validity of the hepatojugular reflux as a clinical test for congestive heart failure". Am J Cardiol. 52 (10): 1299–303. doi:10.1016/0002-9149(83)90592-1. PMID 6650420.