Jugular Veins

8/14/2019 Jugular Veins

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Jugular veinsJugular 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.


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Jugular venous pressure:Jugular venous pressure:

Pressure in the jugular veins reflects right atrialPressure in the jugular veins reflects right atrial

pressure. It is best estimated from the internal jugularpressure. It is best estimated from the internal jugular

veins. If not seen, the external jugular veins could beveins. If not seen, the external jugular veins could be

used. However, it is less reliable.used. However, it is less reliable.

To determine the level of venous pressure find theTo determine the level of venous pressure find the

highest point of oscillations in the internal jugularhighest point of oscillations in the internal jugular

veins or the point above which the external jugularveins or the point above which the external jugularvein appear collapsed.vein appear collapsed.


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Jugular venous pressure

in a healthy subject


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The reference point forThe reference point for

estimating the venousestimating the venous

pressure is the sternal angle.pressure is the sternal angle.

This is because the sternalThis is because the sternal

angle is roughly 5 cm aboveangle is roughly 5 cm abovethe mid-right atrium,the mid-right atrium,

regardless of the patient'sregardless of the patient's

position (supine or sittingposition (supine or sitting

upright). Venous pressure isupright). Venous pressure is

measured in vertical distancemeasured in vertical distance

for it.for it.


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a wave:a wave: due to atrial contraction. It occurs justdue to atrial contraction. It occurs just

before the first heart soundbefore the first heart sound

c wave:c wave: transmitted from the carotid artery.transmitted from the carotid artery.

v wave:v wave: occurs while the tricuspid valve isoccurs while the tricuspid valve isshut. It is associated with atrial filling (venousshut. It is associated with atrial filling (venous

return)return)

The fall in the venous pressure after the "a"The fall in the venous pressure after the "a"

wave is called thewave is called the "x" descent"x" descent & that after "v"& that after "v"

wave is called thewave is called the "y" descent"y" descent..


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Differences between atrial andDifferences between atrial and

venous pulsations:venous pulsations:CarotidCarotid JugularJugular

1 peak per heart beat1 peak per heart beat 2 peaks per beat2 peaks per beat

PalpablePalpable ImpalpableImpalpable

Independent ofIndependent of

respirationrespiration Varies with respirationVaries with respiration

(falls with inspiration)(falls with inspiration)

independent of positionindependent of position Varies with position ofVaries with position of

the patientthe patient


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Examination sequence:Examination sequence:

Position of the patient reclining supine atPosition of the patient reclining supine at

45 in good light45 in good light

Ensure that the neck muscles are relaxedEnsure that the neck muscles are relaxed

by resting the back of the head on a pillowby resting the back of the head on a pillow

Look across the neck from the right side ofLook across the neck from the right side of

the patientthe patient


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Identify the internal jugular pulsationsIdentify the internal jugular pulsations

Estimate the vertical height in cm betweenEstimate the vertical height in cm between

the top of the venous pulsation and thethe top of the venous pulsation and the

sternal angle to give the venous pressure.sternal angle to give the venous pressure.


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Abnormalities of the jugularAbnormalities of the jugular

veins:veins:Congested and pulsating:Congested and pulsating:

Heart failureHeart failure

Pericardial effusionPericardial effusion Constrictive pericarditisConstrictive pericarditis

Pulmonary embolismPulmonary embolism


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congested and non-pulsating:congested and non-pulsating:

superior vena caval obstructionsuperior vena caval obstruction


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Abnormalities of jugular veinsAbnormalities of jugular veins

wave form:wave form: Absent a waves in atrial fibrillationAbsent a waves in atrial fibrillation

Prominent a wave in pulmonaryProminent a wave in pulmonary

hypertensionhypertension

Prominent v wave in tricuspid regurgeProminent v wave in tricuspid regurge

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Jugular Veins