Jugular veins

Anatomy:
External jugular vein: extends from the angle of the
mandible downwards and obliquely superficial to the
sternomastoid till the apex of the posterior triangle
where it pierces the platysma and deep fascia to join
the internal jugular vein.

Internal jugular vein: descends lateral to the carotid

behind the medial edge of the stenomastoid muscle.
 Jugular venous pressure:
Pressure in the jugular veins reflects right atrial
pressure. It is best estimated from the internal jugular
veins. If not seen, the external jugular veins could be
used. However, it is less reliable.

To determine the level of venous pressure find the

highest point of oscillations in the internal jugular
veins or the point above which the external jugular
vein appear collapsed.
Jugular venous pressure
in a healthy subject
The reference point for
estimating the venous
pressure is the sternal angle.
This is because the sternal
angle is roughly 5 cm above
the mid-right atrium,
regardless of the patient's
position (supine or sitting
upright). Venous pressure is
measured in vertical distance
for it.
 Jugular venous pulsations:
It reflects the sequence of pressure
changes within the right atrium. The
venous pulse has 3 components; the a, c
and v waves.
“a” wave: due to atrial contraction. It occurs just
before the first heart sound

“c” wave: transmitted from the carotid artery.

“v” wave: occurs while the tricuspid valve is

shut. It is associated with atrial filling (venous
return)

The fall in the venous pressure after the "a"

wave is called the "x" descent & that after "v"
wave is called the "y" descent.
 Differences between atrial and
venous pulsations:
Carotid Jugular

1 peak per heart beat 2 peaks per beat

Palpable Impalpable

Independent of Varies with respiration

respiration (falls with inspiration)
independent of position Varies with position of
the patient
 Examination sequence:
 Position of the patient reclining supine at
45° in good light

 Ensure that the neck muscles are relaxed

by resting the back of the head on a pillow

 Look across the neck from the right side of

the patient
 Identify the internal jugular pulsations

 Estimate the vertical height in cm between

the top of the venous pulsation and the
sternal angle to give the venous pressure.
 Abnormalities of the jugular
veins:
Congested and pulsating:

 Heart failure
 Pericardial effusion
 Constrictive pericarditis
 Pulmonary embolism
congested and non-pulsating:

 superior vena caval obstruction

 Abnormalities of jugular veins
wave form:
 Absent a waves in atrial fibrillation

 Prominent a wave in pulmonary

hypertension

 Prominent v wave in tricuspid regurge