Jugular venous distension

Interpretation

An elevated JVP is the classic sign of venous hypertension (e.g. right-sided heart failure). JVP elevation can be visualized as jugular venous distension, whereby the JVP is visualized at a level of the neck that is higher than normal. The jugular venous pressure is often used to assess the central venous pressure in the absence of invasive measurements (e.g. with a central venous catheter, which is a tube inserted in the neck veins). A 1996 systematic review concluded that a high jugular venous pressure makes a high central venous pressure more likely, but does not significantly help confirm a low central venous pressure. The study also found that agreement between doctors on the jugular venous pressure can be poor, calling into question its reliability as a clinical decision-making tool. Similarly, a 2016 study examined the use of JVP measurements by clinical examination in the evaluation of central venous pressure in patients with heart failure. This study found that JVP examination was not consistent with actual central venous pressures, such that it was unreliable both for ruling in and ruling out heart failure. JVP measurement was especially unreliable in patients with high body fat. Additionally, it was noted that clinicians seemed to "extrapolate" JVP measurements from other, more easily examinable findings (like lung auscultation, body weight, heart rate, brachial blood pressure, and chest radiography findings).