A physical cardiac examination is essential for the assessment of heart structure and function and the detection of any abnormalities. Physical cardiac examination is not restricted to auscultation of heart sounds using a stethoscope, as palpation of arterial pulse, measurement of blood pressure, inspection of general appearance, and examination of the neck, extremities, mouth, skin, and nails have a critical role.
Neck examination through assessing the jugular vein pulse and identifying any distention can aid in the evaluation of central vein pressure and the diagnosis of valvular heart diseases and atrial arrhythmia.
Jugular vein pressure (JVP)
Jugular vein pressure is assessed using the right internal jugular vein, which is located at the right side of the nick underneath the sternocleidomastoid muscle between the ear, the lobe, and the medial clavicle. The patient must be set at 30°–45° elevated from the supine position while slightly turning the head to the left.
When the jugular vein is assessed, two pulses will be visualized for each heartbeat, but they are not palpable pulsations. Also, the pressure will be temporarily elevated as a hepatojugular reflex in the case of pressing on the right upper quadrant of the abdomen. In addition, the jugular vein will normally collapse during inspiration.
Jugular vein pressure height is measured vertically from the sternal angle to the intersection point with the horizontal level of jugular vein pulsation, which is shorter than 3cm under normal conditions. Then, five is added to the jugular vein height to convert it to jugular vein pressure in cm H2O units.
JPV and atrial waveforms
Jugular vein pressure can be used as an indirect measurement of right atrium pressure since non-oxygenated blood moves directly through it to the superior vena cava and right atrium. As a result, several waves are formed and reflect atrial conditions.
Atrial contraction increases atrial pressure, which leads to blood movement through the tricuspid valve into the right ventricle, as well as blood movement back into the jugular vein, which increases its pressure.
Ventricular systole results in elevated pressure and bulging of the closed tricuspid valve, which leads to back pressure at the right atrium and jugular vein.
Due to atrial relaxation, atrial pressure is dropped, which indirectly causes a drop in jugular vein pressure.
Atrium venous filling increases the atrial pressure and leads to blood backflow into a jugular vein as the tricuspid valve is closed at this phase.
In this phase, the tricuspid valve is opened and ventricular filling is accelerated, so atrium and jugular vein pressure are falling.
Cardiac conditions related to JVP and atrial waves
References
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