Advanced Physical Diagnosis
  • Techniques
• Jugular Venous Pressure
• Jugular Waveforms
  • Demonstrations
Associated Evaluations
  • Patient HX
  • Physical Exam
  • Laboratory & Imaging
Differential Dx
Evidence Base
• Measurement of Jugular Venous Pressure
• Hepatojugular Reflux (HJR)
• Cardiac Hemodynamics
Teaching Tips
[Skill Modules >> Neck & Veins Examination >> Laboratory & Imaging ]

Laboratory & Imaging: Neck Veins

The etiology of heart failure is divided into three categories: elevated left ventricular (LV) filling pressure, LV ejection fraction under 40%, and diastolic dysfunction.

Ancillary tests enhance the ability to diagnose which type of heart failure is present. Below is a summary of echocardiography and radiology data, and findings most suggestive in each category of heart failure.

Postero-anterior view Lateral View
chest xray postero-anteriorview
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chest xray lateral view
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Normal chest x-ray with normal pulmonary veins
chest xray postero-anterior view chest xray lateral view
Chest x-ray with pulmonary edema
chest xray pulmonary edema

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Data from one study comparing the sensitivity and specificity of jugular venous distention with other studies are shown:
Clinical Findings to Detect Types of Heart Failure Sensitivity Range Specificity Range
Increased filling pressure
Radiographic redistribution 10% to 58% 79% to 100%
Jugular venous distention 55% to 65% 74% to 80%
Ejection fraction <40%
Radiographic cardiomegaly or redistribution 4% to 33% 87% to 100%
Anterior q-waves 32% to 44% 89%
Left-bundle branch block 18% 95%
Abnormal apical impulse 31% to 36% 89% to 95%
Diastolic dysfunction
Current hypertension 60% to 61% 59% to 70%

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