Jugular Venous Pressure - Interpretation

Interpretation

Certain wave form abnormalities, include "Cannon a-waves", or increased amplitude 'a' waves, are associated with AV dissociation (third degree heart block), when the atrium is contracting against a closed tricuspid valve, or even in ventricular tachycardia. Another abnormality, "c-v waves", can be a sign of tricuspid regurgitation. The absence of 'a' waves may be seen in atrial fibrillation.

An elevated JVP is the classic sign of venous hypertension (e.g. right-sided heart failure). JVP elevation can be visualized as jugular venous distension, whereby the JVP is visualized at a level of the neck that is higher than normal. The paradoxical increase of the JVP with inspiration (instead of the expected decrease) is referred to as the Kussmaul sign, and indicates impaired filling of the right ventricle. The differential diagnosis of Kussmaul's sign includes constrictive pericarditis, restrictive cardiomyopathy, pericardial effusion, and severe right-sided heart failure.

• Raised JVP, normal waveform
  • Bradycardia
  • Fluid overload
  • Heart Failure
• Raised JVP, absent pulsation
  • Superior vena cava syndrome
• Large 'a' wave (increased atrial contraction pressure)
  • tricuspid stenosis
  • Right heart failure
  • Pulmonary hypertension
• Cannon 'a' wave (atria contracting against closed tricuspid valve)
  • Atrial flutter
  • Premature atrial rhythm (or tachycardia)
  • third degree heart block
  • Ventricular ectopics
  • Ventricular tachycardia
• Absent 'a' wave (no unifocal atrial depolarisation)
  • atrial fibrillation
• Large 'v' wave (c-v wave)
  • Tricuspid regurgitation
• Slow 'y' descent
  • Tricuspid stenosis
• Parodoxical JVP (Kussmaul's sign: JVP rises with inspiration, drops with expiration)
  • Pericardial effusion
  • Constrictive pericarditis
  • Pericardial tamponade

An important use of the jugular venous pressure is to assess the central venous pressure in the absence of invasive measurements (e.g. with a central venous catheter, which is a tube inserted in the neck veins). A 1996 systematic review concluded that a high jugular venous pressure makes a high central venous pressure more likely, but does not significantly help confirm a low central venous pressure. The study also found that agreement between doctors on the jugular venous pressure can be poor.