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[Skill Modules
>>
Neck & Veins Examination
>>
Physical Exam
]
Physical Exam: Neck Veins
JVP
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
Arrhythmia
- 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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