Elevated Jugular Venous Pressure
The traditional “window” for viewing the jugular venous pulse is confined to the region of the neck between the clavicle and the angle of the jaw. However, when central venous pressure is markedly elevated, the jugular venous pulse may not be readily visible within that window, even with the patient sitting in the upright position. In such circumstances, be sure to look above the jaw as the pulse is often transmitted by veins of the periauricular area, temple, or forehead.
Patient 1:
This patient was admitted to the hospital with decompensated heart failure. The videos demonstrate the jugular venous waveform near the angle of the jaw with the patient inclined to 60 degrees.
Upper Neck
Narrated
Patient 2:
This patient has markedly elevated central venous pressure. The unmistakable “inward” movements of the jugular venous pulse are visible in the periauricular area. If the jugular venous pulse cannot be located in the neck, you must always look higher as it is often seen in the periauricular area, the temple, or the forehead.
Periauricular
Patient 3:
This patient was admitted to the hospital with decompensated heart failure. She had long-standing heart failure and her body had adapted to markedly elevated filling pressures. These videos demonstrate the venous waveform in the region of the patient’s temple. Many of the doctors who evaluated her reported that they could not find the jugular venous pulse.
This patient also has an “ejection rattle” from a Starr-Edwards prosthetic valve in the aortic position.
Temple
Patient 4:
This is a patient with severe tricuspid regurgitation who was admitted to the hospital with decompensated heart failure. She was noted to have markedly elevated filling pressures. This video demonstrates the venous waveform in the patient’s forehead.
Forehead
Patient 5:
This is a middle-aged woman with severe tricuspid regurgitation complicated by right-sided heart failure.
Temple
Forehead
Patient 6:
This is an older man who was admitted to the hospital for treatment of an underlying malignancy. He was being evaluated for diagnostic and therapeutic paracentesis when he was found to have markedly elevated jugular venous pressure and subsequently diagnosed with congestive heart failure. Right heart catheterization revealed a right atrial pressure of 30 mm Hg.
Patient 7:
This is an older woman with end-stage renal disease who was found to have markedly elevated central venous pressure. Notice the absence of visible forehead veins in the upright position (beginning of video) that engorge with blood when the patient is moved to a more supine position (end of video).
Patient 8:
This is a young woman with decompensated heart failure.
This patient also has marked peripheral edema.
Patient 9:
This patient has elevated jugular venous pressure.
Patient 10:
This is a middle aged man with a new diagnosis of toxin-induced cardiomyopathy with markedly elevated filling pressures.
