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 >> Physical Exam ]

Physical Exam: Neck Veins


Increased JVP
Other common signs of fluid overload include:
  • Peripheral edema
  • Displaced PMI (cardiomegaly)
  • S3
  • Pulmonary crackles
  • Hepatomegaly (passive liver congestion)
  • Hepatojugular reflux
Decreased JVP
Signs of volume depletion include:
  • Orthostatic hypotension
    • Measurement differences in BP and pulse when patient changes from lying to standing position.
    • Definitions and relability of exam vary but commonly defined as reduction in systolic BP of 20 points and diastolic BP reduction of 10 points with a rise in pulse of 20 points.
    • Note that interpretation of orthostatic measurements of BP and pulse are particularly problematic in patients with autonomic neuropathy or on medicaitons that can lower pulse (i.e., beta-blockers).
  • Poor skin turgor (commonly done--unreliable, especially in elderly)

Waveform Analysis

  • Pulse irregularity (pattern may be diagnostic)
  • Fluid overload
  • Hepatomegaly (passive liver congestion)
Valvular heart disease
  • Murmurs (link opens a new window)
  • Signs of ventricular failure

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