Jugular Venous Distension

Jugular Venous Distension: Excerpt from In a Page: Signs and Symptoms

Examination of the jugular venous pulse for abnormalities of the wave form or level of venous pressure is a critical component of the cardiovascular exam and can aid in the diagnosis of certain cardiac diseases.

Differential Diagnosis

• Congestive heart failure
• Constrictive pericarditis
• Cardiac tamponade
• Superior vena cava syndrome
• Tricuspid regurgitation
• Heart block (most often complete heart block)
• Atrial fibrillation
• Right ventricular infarction
• Tricuspid stenosis
• Right ventricular dilation
• Hypervolemia

Workup and Diagnosis

• History and physical examination
  –Best to evaluate the right internal jugular vein
  –Best seen in tangential light from foot of bed
  –Venous pulsation can be obliterated with compression, but arterial pulsation cannot
  –Right atrium lies 5 cm below the sternal angle (reference point)
  –Normal central venous pressure ≤8–9 cm
  –Hepatojugular reflex is a helpful adjunct in patients with normal central venous pressure suspected of having right heart failure

• ECG may reveal atrial fibrillation, ventricular tachycardia, right ventricular infarction, heart block, or other pathology
• Chest X-ray may reveal signs of congestive heart failure or cardiomegaly
• Echocardiogram is helpful to evaluate for valvular disease, myxomas, and right ventricular dysfunction
• Additional diagnostic testing depends on the suspected pathology

Treatment

• Treatment depends on the underlying disease process
• Atrial fibrillation
• Ventricular tachycardia: DC countershock in presence of hemodynamic instability; antiarrhythmic therapy with amiodarone or lidocaine; repletion of electrolytes with torsade de pointes; ICD to treat recurrences
• Constrictive pericarditis: Judicious management of volume status; pericardial stripping hemodynamic compromise is substantial
• Tricuspid regurgitation/stenosis: Surgical correction if symptomatic or severe enough
• Atrial myxoma: Surgical excision
• Heart block may require permanent pacemaker

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

More About Arteriovenous Malformation

• Back to disease: Arteriovenous Malformation: Introduction
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Arteriovenous malformations (Professional Guide to Diseases (Eighth Edition))

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