Jugular venous distention resident survival guide

Jump to navigation Jump to search


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Jugular venous distension (JVD), or an elevated jugular venous pressure (JVP), is considered a useful physical finding for assessing ventricular filling pressures and central venous pressure (CVP). JVD is defined as an estimated JVP ≥10 cm H2O.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.


Common Causes


Diagnosis

Shown below is an algorithm summarizing the diagnosis of jugular venous distension according to the ACC and ESC guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Without pulmonary edema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Increased right atrial pressure
 
Venous obstruction
 
Increased intrathoracic pressure
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Restriction of right atrial and right ventricular filling:

Cor pulmonale (Massive pulmonary emboli, COPD)
Pulmonary Hypertension
Constrictive pericarditis
Cardiac Tamponade

RV Failure:

Cardiomyopathy
RV myocardial infarction

Fluid overload due to renal diseasesTricuspid valve incompetence

Tricuspid valve stenosis or obstruction
 
Superior vena cava obstrcution
 

Treatment

  • The management of jugular venous distension should be directed towards the underlying causes.
  • For congestive heart failure, treatment usually includes diuretics (for symptom relief), beta blockers, angiotensin converting enzyme inhibitors (ACE-I) /aldosterone receptor blockers (ARB).
    • For a complete guide on the treatment of congestive heart failure, click here.
  • For right ventricular myocardial infarction, treatment includes reperfusion, maintenance of right ventricular preload, decreasing right ventricular afterload, restoring cardiac rate/rhythm and atrioventricular synchrony, and inotropic support.
    • For a complete guide on the treatment of right ventricular myocardial infarction, click here.
  • Treatment of massive pulmonary embolism usually includes fibrinolytic therapy.
    • For a complete guide on the treatment of pulmonary embolism, click here.
  • Treatment of pericardial tamponade usually includes pericardiocentesis.
    • For a complete guide on the treatment of cardiac tamponade, click here.
  • Treatment of tension pneumothorax includes immediate needle decompression followed by chest tube insertion.
    • For a complete guide on the treatment of tension pnemuothorax, click here.

Do's

  • If the JVP does not seem elevated when the patient is supine, a provocative test, i.e., abdominojugular test, should be performed.

Don'ts

  • JVD only provides clues to the presence of an elevated CVP. Clinicians should avoid making decisions about the degrees of CVP elevation based on the JVP measurement.

References


Template:WikiDoc Sources