Jugular Venous Pressure (JVP) > The JVP level reflects right atrial pressure. » Normal JVP <4cm cf water above the sternal angie when the patient s at 45°(recombinant position). & The sternal angle is approximately 5 em above the right atrium. > JNP +5 cm = right atrial pressure (central venous pressure CVP). > Normal CVP <9 cm of water (7 cm of Hg). How to examine the JVP The patient should lie at 45°. Examine the internal (not the external) jugular vein. Examine the right (not the left) internal jugular vein. ‘Ask the patient to turn his head slightly to the left. Between the to heads of the sternocleidomastoid muscle lateral to the internal carotid artery, look for the internal jugular vein. You see double peak pulsation of the intemal jugular vein. From the highest point of pulsation of the internal jugular vein, draw a horizontal line toward the sternal angle . Y Draw a vertical line from the sternal angle to cross with the vertical line. ’ The distance between the sternal angle and the horizontal line is the JVP which is ranging fro 0-4 cm of water. SS <4 Dr. Imad H. Tahir-Senior Consultanc Of Internal Medicine. 2020-2021.JVP examination Causes of raised JVP include: Heart failure (right sided and congestive heart failure). Constrictive pericarditis. Superior vena cava (SVC) obstruction. Pericardial effusion. Cardiac tamponade. Tricuspid valve disease. Imad H. Tahir-Senior Corsultant Of Internal Medicine. 2020-2021. a YY VY VVWhy we should exam the right not the left internal jugular vein UV Right UV is preferred to left UV because: Right UV @ Straight line course through innominate vein to the SVC and right atrium. @ Less likely extrinsic compression from other structures in the neck. * Left JV @ Left innominate vein may be compressed by dilated aorta or an aneurysm. e@ Drains into left innominate vein, which is not in straight from SVC and right atrium. Dr. (mad H. Tahir-Senior Consultant Of internal Medicine. 2020-2021.Distinguishing the jugular Veins from from the Carotid Ate Characteristic Jugular Veins Carotid Arteries Movement Two inward movements per ventricular One outward movement per systole ventricular systole Pulsations Not palpable Easily palpated Change with inspiration Pulsations diminish but become more No change prominent in lower part of neck during inspiration Change with position Pulsations decrease when sitting up No change Change with abdominal pressure _Pulsations become more prominent and No change move higher in neck“To examine for flapping tremor: Askthe patient to outstretch his/her arms and fingers separated or by hyperextending the wristswith the forearms fixed (as if he/she is pushing a wall) and wait for 20 seconds to see if there is asterixis or not. Dr Imad H. Tahir-Senior Consultant Of Internal Medicine. 2020-2021.