Common abnormalities

Raised jugular venous pressure. Heart failure is the com-

Measuring Height Jvp
Flg. 3.22 Measuring the height of the JVP.

TABLE 3.21 Abnormalities of the jugular venous pulse

Condition

Abnormalities

Heart failure

Elevation, sustained abdomino|ugular

reflux

Pulmonary embolism

Elevation

Pericardial effusion

Elevation, prominent 'y' descent

Pericardial constriction

Elevation, Kussmaul's sign

Superior vena caval obstruction

Elevation, loss of pulsation

Atrial fibrillation

Absent-a'waves

Tricuspid stenosis

Giant 'a waves

Tricuspid regurgitation

Giant V waves

Complete heart block

'Cannon' waves

nionest cause of a raised jugular venous pressure (see Table 3.21). In milder degrees of heart failure abdominojugular reflux results in a rise in pressure which is sustained while abdominal pressure is applied. In major pulmonary embolism the JVP may be so elevated that it is missed in a semi-recumbent position. Marked elevation also occurs in SVC obstruction when the vessel is non-pulsatile. In pericardial constriction the JVP is elevated and ihere is a characteristic paradoxical rise on inspiration (Kussmaul's sign).

Serial estimations of the jugular venous pressure give valuable information regarding response to treatment; e.g. a reduction in the pressure as a result of effective diuretic therapy in the patient with heart failure.

Waveform. Abnormalities of jugular venous pulsation are also given in Table 3.21. In atrial fibrillation there is no atrial systole. This results in the loss of the 'a' wave and the characteristic double impulse.

Prominent 'a' waves arc seen in any condition that restricts blood flow from the right atrium to the right ventricle, e.g. pulmonary hypertension and, rarely, tricuspid stenosis.

Cannon waves are giant *a' waves occurring when the right atrium contracts against a closed tricuspid valve. They are seen as impulses shooting up the neck. Cannon waves occur with complete heart block and in both ventricular and supraventricular tachycardias.

A prominent V wave is characteristic oT tricuspid regurgitation. When severe this may be associated with pulsation of the liver.

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