jvp

PRESENTED BY : 

DR.SANJYA KUMAR ROUT PGDCC CARE HOSPITAL,BBSR. PRESENTED BY JUGULAR VENOUS PRESSURE

INTRODUCTION : 

IMPORTANCE:- It explain the filling pattern of Rt ventricle & also explain the pressure change in Rt atrium. VEIN SELECTED :- Internal jugular vein. :Why not ext. jugular vein ? -Two reasons…… Presence of venous valves within ext.jugular vein prevents it being a pure conductor of more central pressure changes. Ext.jugular vein passes through more facial plane than the I.J.V. & so it more likely to be affected by extrinsic compression from other structures in the neck & upper thorax INTRODUCTION

HOW TO EXAMINE ? : 

Examine the neck vein with the patient in a good light & an angle of about 45 degrees The neck should be supported so that the neck muscles ,especially the strenomastoids are relaxed. There is however a mean level,& the perpendicular height of this level above the mid rt atrium indicates the mean hydrostatic pressure within the rt atrium (6-8 cmH2O). In health this level is the same as that of sternal angle, whatever the position of the patient. HOW TO EXAMINE ?

EXAMINATION : 

EXAMINATION

HOW TO DIFFERENTIATE ATRIAL & VENOUS PULSATION IN THE NECK ? : 

HOW TO DIFFERENTIATE ATRIAL & VENOUS PULSATION IN THE NECK ?

TYPES OF WAVES : 

There is three positive waves i.e. a,c,v & Two negative waves I.e. x & y descent a -Wave is due to atrial contraction X- descent due to atrial relaxation; descent of AV septum v -Wave is indicates the atrial filling y -descent due to RV fillings/ atrial emptying C -wave coincides with the onset of ventricular systole. TYPES OF WAVES

NORMAL JVP : 

NORMAL JVP a c X V y a c x v y

EVALUATION : 

The following features have to be noted in the JVP for optimal clinical information. Level Wave pattern Respiratory variation in level & wave pattern Hepatojugular reflux. Venous hum , liver size & pulsations. EVALUATION

EVALUATION : 

LEVEL:-- As sternal angle is readily available, all measurements of jugular venous pulse can be made starting from that point ;adding 5cm gives the total rt atrial pressure. CAUSE OF ELEVATED JVP;- Superior venacaval obstruction Right ventricular failure due to any cause. TR/TS Pericardial compression(constriction / tamponade ) Circulatory overload Renal failure Excessive fluid administration ASD with mitral valve disease. EVALUATION

WAVE PATTERN : 

ABNOMALITY OF a- WAVE:- Absence of a-wave;- It is a feature in AF as there is no atrial click. it also seen in sinus rhythm immediately after cardiovertion of AF.it also seen in sinoventricular conduction in Hyperkalemia. Prominent a –wave;- It occurs when the TV is obstructed as in TS or when atrium contracts against a non-compliant rt ventricle as in severe concentric Rt ventricular hypertrophy. Cannon wave ;- In situation where the TV is closed at time of atrial contraction, all the atrial energy is wasted away into the neck veins as a very prominent a – wave called cannon wave It also seen in all the condition with A-V dissociation like VT,CHB,VPC,etc. WAVE PATTERN

ABNORMALITIES OF X-DESCENT : 

Normally during x descent the atrial pressure is falling due to relaxation of the atrium & also descent of the AV septum. If for some reason the atrial pressure fails to fall, the x-descent gets obliterated e.g. in AF , TR, etc. Occasionally an x –descent may be seen in spite of AF particularly in patients with constrictive pericarditis dominantly involving the AV groove. Prominent x- descent seen in cardiac tamponade. ABNORMALITIES OF X-DESCENT

ABNORMALITIES OF V-WAVE : 

The v –wave reflect the filling pattern of the RT atrium & depends on the venous return of through the venae cavae. If there is any exaggerated filling of Rt atrium as in conditions where the venous pressure is high ( such as Rt ventricle failure or constrictive pericarditis )or when there is more than one source for the rt atrium to fill, as in TR,ASD,&ASD with MR the v-wave is prominent. V – wave is diminish in Hypovolemia & with use of venodilator (nitrate ) ABNORMALITIES OF V-WAVE

ABNORMALITIES OF Y-DESCENT : 

During y –descent the atrial pressure are falling & the ventricular pressure is rising. All abnormalities related to atrial emptying or ventricular filling should naturally influence the y – descent Rapid y descent seen in all causes of prominent v – wave Slow y descent seen in TS , Pericardial tamponade, Tension pneumothorax. ABNORMALITIES OF Y-DESCENT

VENOUSE HUM : 

The normal flow of blood across normal veins in the neck is noiseless. However, when there is increased velocity of flow (hyperkinetic state such as in thyrotoxicosis) or in diminished viscocity of blood (as in anemia ) there occurs a continuous bruit over the neck veins. this is called venous hum. VENOUSE HUM

Causes of venous hum : 

Causes of venous hum

RESPIRATION VARIATION : 

Normally during inspiration venous return to the rt side of the heart increases. However this is accommodated by the inspiratory decrease in pulmonary vascular impedance. as a result the pulmonary art. ,RV, & RA pressures fall in spite of increased venous return. During expiration the lungs are squeezed of their air & the pulmonary circulation is compressed by the thoracic cage increasing the pulmonary impedance & pressures. As a result the venous column rises during expiration & fall in inspiration. RESPIRATION VARIATION

RESPIRATORY VARIATION : 

In conditions where the increase in venous return of inspiration cannot be translated as more pulmonary filling ,inspiratory filling of neck veins occurs ,which is called KUSSMAUL’s sign & occurs in constrictive pericarditis, restrictive cardiomyopathy, TS or severe RV failure. RESPIRATORY VARIATION

HEPATOJUGULAR REFLUXES. : 

When the venous return is increased to the Rv, it readily accommodates it & translates it as more output into the lungs & there is only a transient rise in pressure. Abdominal compression increases venous return further & results in only a transient rise in jugular venous pressure with the RV emptying the veins in the next few beats. In presence of RV dysfunction, abdominal compression results in a longer duration of pressure rise As a guide line a 10 sec.abdominal compression result in rise in JVP that last less than 10 sec.; if it persist more than 15 sec. it is suggestive of RV dysfunction HEPATOJUGULAR REFLUXES.

LIVER PULSATION : 

The liver should be an extension of RA cavity. It generally reflects the jugular venous pressure rise by enlaregment,jugular venous pulsations like ,a ,v-wave & rapid y-descent are easily evident over the liver. In infant the liver is the only guide to recognition of elevated rt atrial pressure as the JVP is difficult to delineate. LIVER PULSATION

PROMINENT a -WAVE : 

PROMINENT a -WAVE

CANNON WAVE (REGULLAR) : 

CANNON WAVE (REGULLAR)

IRREGULAR CANNON WAVE. : 

IRREGULAR CANNON WAVE.

CNSTRICTIVE PERICARDITIS. : 

CNSTRICTIVE PERICARDITIS.

TRICSPID STRENOSIS : 

TRICSPID STRENOSIS

TRICUSPID REGURGITATION : 

TRICUSPID REGURGITATION

CONTINEOUS MURMUR OF VENOUS HUM : 

CONTINEOUS MURMUR OF VENOUS HUM

HEPATOJUGULAR REFLUX : 

HEPATOJUGULAR REFLUX

Slide 28: 

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