{"id":1669,"date":"2020-05-18T10:04:31","date_gmt":"2020-05-18T17:04:31","guid":{"rendered":"https:\/\/up.physicaldiagnosispdx.com\/up\/?page_id=1669"},"modified":"2021-04-29T21:59:56","modified_gmt":"2021-04-30T04:59:56","slug":"elevated-jugular-venous-pressure","status":"publish","type":"page","link":"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-multimedia-new\/elevated-jugular-venous-pressure\/","title":{"rendered":"Elevated Jugular Venous Pressure"},"content":{"rendered":"<div class=\"wpb-content-wrapper\">[vc_row css=&#8221;.vc_custom_1592017154846{background-color: #fff9f9 !important;}&#8221;][vc_column][vc_column_text]<span style=\"font-size: 14pt;\">The traditional \u201cwindow\u201d 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.<\/span><br \/>\n<figure id=\"attachment_1658\" aria-describedby=\"caption-attachment-1658\" style=\"width: 150px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-2\/card-tutorial\/#Elevated_Jugular_Venous_Pressure_upper_neck\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-1658 size-thumbnail\" src=\"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308-150x150.png\" alt=\"\" width=\"150\" height=\"150\" srcset=\"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308-150x150.png 150w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308-300x300.png 300w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308.png 512w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a><figcaption id=\"caption-attachment-1658\" class=\"wp-caption-text\">&nbsp;<\/figcaption><\/figure>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 1:<\/h1>\n<p><span style=\"font-size: 14pt;\">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.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592017173859{background-color: #dcd9dd !important;}&#8221;][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><strong><span style=\"font-size: 18pt;\">Upper Neck<\/span><\/strong><\/p>\n<p style=\"text-align: center;\">\n<iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472307745?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe>[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><span style=\"font-size: 18pt;\"><strong>Narrated<\/strong><\/span><\/p>\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/507197223\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 2:<\/h1>\n<p><span style=\"font-size: 14pt;\">This patient has markedly elevated central venous pressure. The unmistakable &#8220;inward&#8221; 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.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592017190414{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><strong><span style=\"font-size: 18pt;\">Periauricular<\/span><\/strong><\/p>\n<p style=\"text-align: center;\">\n<iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472339244?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1 id=\"patient3\">Patient 3:<\/h1>\n<p><span style=\"font-size: 14pt;\">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&#8217;s temple. Many of the doctors who evaluated her reported that they could not find the jugular venous pulse.<\/span><\/p>\n<p><span style=\"font-size: 14pt;\">This patient also has an <a href=\"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-2\/cardiology-multimedia-new\/starr-edwards-prosthetic-valve\/#patient1\" target=\"_blank\" rel=\"noopener noreferrer\">&#8220;ejection rattle&#8221; from a Starr-Edwards prosthetic valve<\/a> in the aortic position.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592017206436{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><strong><span style=\"font-size: 18pt;\">Temple<\/span><\/strong><\/p>\n<p style=\"text-align: center;\">\n<iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472309865?loop=1\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 4:<\/h1>\n<p><span style=\"font-size: 14pt;\">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&#8217;s forehead.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><strong><span style=\"font-size: 18pt;\">Forehead<\/span><\/strong><\/p>\n<p style=\"text-align: center;\">\n<iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472308781?loop=1\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 5:<\/h1>\n<p><span style=\"font-size: 14pt;\">This is a middle-aged woman with severe tricuspid regurgitation complicated by right-sided heart failure.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><strong><span style=\"font-size: 18pt;\">Temple<\/span><\/strong><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472326432?loop=1\" width=\"640\" height=\"352\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&amp;amp;amp;lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&amp;amp;amp;gt;\ufeff&amp;amp;amp;lt;\/span&amp;amp;amp;gt;<\/iframe><\/p>\n[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><strong><span style=\"font-size: 18pt;\">Forehead<\/span><\/strong><br \/>\n<iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472326171?loop=1\" width=\"640\" height=\"352\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&amp;amp;amp;amp;amp;lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&amp;amp;amp;amp;amp;gt;\ufeff&amp;amp;amp;amp;amp;lt;\/span&amp;amp;amp;amp;amp;gt;<\/iframe>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 6:<\/h1>\n<p><span style=\"font-size: 14pt;\">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.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column width=&#8221;1\/2&#8243;][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/497755356?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_column_text]<div id='gallery-1' class='gallery galleryid-1669 gallery-columns-3 gallery-size-medium'><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/up.physicaldiagnosispdx.com\/up\/img_2128\/'><img loading=\"lazy\" decoding=\"async\" width=\"225\" height=\"300\" src=\"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/IMG_2128-225x300.jpg\" class=\"attachment-medium size-medium\" alt=\"\" srcset=\"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/IMG_2128-225x300.jpg 225w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/IMG_2128-768x1024.jpg 768w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/IMG_2128-1152x1536.jpg 1152w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/IMG_2128-1536x2048.jpg 1536w\" sizes=\"auto, (max-width: 225px) 100vw, 225px\" \/><\/a>\n\t\t\t<\/div><\/figure><figure class='gallery-item'>\n\t\t\t<div class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/up.physicaldiagnosispdx.com\/up\/img_2126\/'><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"225\" src=\"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/IMG_2126-300x225.jpg\" class=\"attachment-medium size-medium\" alt=\"\" srcset=\"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/IMG_2126-300x225.jpg 300w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/IMG_2126-1024x768.jpg 1024w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/IMG_2126-768x576.jpg 768w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/IMG_2126-1536x1152.jpg 1536w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/IMG_2126-2048x1536.jpg 2048w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a>\n\t\t\t<\/div><\/figure>\n\t\t<\/div>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 7:<\/h1>\n<p><span style=\"font-size: 14pt;\">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).<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/507686820?loop=1\" width=\"640\" height=\"564\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1 id=\"patient8\">Patient 8:<\/h1>\n<p><span style=\"font-size: 14pt;\">This is a young woman with decompensated heart failure. <\/span><\/p>\n<p><span style=\"font-size: 14pt;\">This patient also has marked <a href=\"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-multimedia-new\/pedal-edema\/#patient2\" target=\"_blank\" rel=\"noopener\">peripheral edema<\/a>.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592017173859{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/542501038?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" data-mce-type=\"bookmark\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][\/vc_column][\/vc_row]\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row css=&#8221;.vc_custom_1592017154846{background-color: #fff9f9 !important;}&#8221;][vc_column][vc_column_text]The traditional \u201cwindow\u201d 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<\/p>\n","protected":false},"author":9,"featured_media":0,"parent":3164,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"page-templates\/page_PDXPDX-full-width.php","meta":{"nf_dc_page":"","_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-1669","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/1669","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/comments?post=1669"}],"version-history":[{"count":18,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/1669\/revisions"}],"predecessor-version":[{"id":10546,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/1669\/revisions\/10546"}],"up":[{"embeddable":true,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/3164"}],"wp:attachment":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/media?parent=1669"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}