Jugular Venous Pulse in Lung Disease
The jugular venous pulse can provide a clue to the presence of lung disease. Decreased intrathoracic pressure during inspiration normally leads to an increase in venous return to the right side of the heart, with an associated decrease in jugular venous pressure. In patients with lung disease, the “normal” inspiratory drop and expiratory rise in jugular venous pressure is amplified. This most likely occurs as a result of the exaggerated drop in inspiratory intrathoracic pressure and rise in expiratory intrathoracic pressure that occurs as a result of altered lung mechanics.
Patient 1:
This patient was admitted to the hospital with an exacerbation of chronic obstructive pulmonary disease. These videos demonstrate a marked inspiratory drop in jugular venous pressure, exaggerated when compared to normal.
Lung Disease
Annotated
Patient 2:
This is a middle-aged man with cystic fibrosis who was admitted to the hospital for an exacerbation. Notice that the external jugular vein fills on expiration and empties on inspiration.
Patient 3:
This is a middle-aged woman with lung disease. Notice the pseudoelevation of the jugular venous pressure on expiration.
Patient 4:
This is an older man with chronic systolic heart failure as well as severe chronic obstructive pulmonary disease.