Vein used

• Internal jugular vein (valveless)
• Reflects events in right heart and thoracic cavity
• Equates to right atrial pressure (circulatory volume) and Right ventricular function

Distinguishing from carotid pulse

1. two pulsations vs one in carotid
2. Venous pulse obliterated by pressure at root of neck
3. JVP height varies with respiration (inspiration - low)
4. Hepato-jugular reflex

Normal JVP waveform

A - Atrial contraction
X - Atrial relaxation
C - Ventricular contraction
V - venous return/filling
Y - opening of tricuspid valve

Raised JVP

• Obstruction to flow into right atrium
• Valve lesions
• Elevated intrathoracic pressure transmitted to right atrium
• Over-filled atrium - excess fluid
• Compressed right ventricle - tamponade, constrictive pericarditis

Waveform changes

1. AF: absent a-wave
2. Heart block: cannon a-waves (discordant contraction)
3. TS: Large a-wave, slow y-descent
4. TR: Large v-wave due to surging of right ventricular blood

Kussmaul's sign

• Rise in JVP on inspiration
• Occurs when right atrium cannot accommodate increase in venous return - back pressure (Rht heart failure, constrictive pericarditis)