Jugular venous distention resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Jugular venous distension (JVD), or an elevated jugular venous pressure (JVP), is considered a useful physical finding for assessing ventricular filling pressures and central venous pressure (CVP). JVD is defined as an estimated JVP ≥10 cm H2O.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
- Acute heart failure
- Massive pulmonary emboli
- Right ventricular myocardial infarction
- Cardiac Tamponade
- Tension Pneumothorax
Common Causes
Diagnosis
Shown below is an algorithm summarizing the diagnosis of jugular venous distension according to the ACC and ESC guidelines.
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.
- For congestive heart failure, treatment 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.
- For right ventricular myocardial infarction, treatment 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, should be performed.
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.