JVP is the pressure in the internal jugular vein, which reflects right atrial pressure.
Why Important? Helps in diagnosing heart failure, pericardial diseases, and volume overload.
HOW TO MEASURE
JVP?
• Patient position: 45° reclined (semi-sitting).
• Look at the right internal jugular vein (not carotid).
• Measure the vertical height from the sternal angle.
• Normal JVP = 0 to 4 cm
Mnemonic: "JVP = 4 STEPS"
- 45° position
- Right Internal Jugular Vein
- Measure Height from Sternum
- Normal = 0-4 cm
JVP
vs. Carotid Pulse (How to Differentiate?)
|
Feature |
JVP (Venous Pulse) |
Carotid (Arterial Pulse) |
|
Palpable? |
No |
Yes |
|
Changes with respiration | Yes (Falls in
inspiration) |
No |
|
Multiple waves? | Yes (a, c, v waves) |
No (Single wave) |
Mnemonic:
"JVP is JUMPY"
- Jugular
moves with Jrespiration
- Up &
Down (Multiple Waves)
- Measured in
cm (Venous Pressure)
- Palpation
absent (Not felt)
- You check it
at 45° angle
JVP WAVES &
MEANING
3 Positive Waves
- a wave → Atrial contraction (Disappears in Atrial Fibrillation)
- c wave → Tricuspid valve bulging into atrium
- v wave → Venous filling of right atrium (Large in Tricuspid Regurgitation)
2 Descents (Troughs)
- x descent → Atrial relaxation
- y descent → Right atrium emptying
Mnemonic: "ACXVY" (JVP Waves)
- A → Atrial
contraction
- C →
Tricuspid Closure bulge
- X → Atrial
RelaXation
- V → Venous
filling
- Y → EmptYing
of atrium
CONDITIONS
AFFECTING JVP
1. RAISED JVP
(Fluid Overload)
Causes:
- Heart Failure
- Constrictive Pericarditis
- Tricuspid Regurgitation
- Superior Vena Cava (SVC) Obstruction
Mnemonic: "HF-CT" (Causes of High JVP)
- Heart
Failure
- Fluid
Overload
- Constrictive
Pericarditis
- Tricuspid
Regurgitation
2. ABSENT
"a" WAVE (No Atrial Contraction)
- Cause: Atrial Fibrillation
- Mnemonic: "A wave Absent in AF"
3. GIANT
"a" WAVE (Strong Atrial Contraction)
Causes:
- Pulmonary Hypertension
- Tricuspid Stenosis
- Right Heart Obstruction
Mnemonic: "Giant 'A' in 'P-T-R'"
- Pulmonary
Hypertension
- Tricuspid
Stenosis
- Right
Obstruction
4. GIANT
"V" WAVE (Excessive Venous Filling)
- Cause: Tricuspid Regurgitation (TR)
- Mnemonic: "V for Very Big in TR"
SPECIAL JVP SIGNS
1. KUSSMAUL'S
SIGN
- JVP rises on inspiration (Normally, it should fall).
- Seen in: Constrictive Pericarditis, Right Heart Failure.
Mnemonic: "Kussmaul = K for Constrictive Pericarditis"
2. CANNON WAVES
(Large a Waves)
- Seen in Complete Heart Block & Ventricular Tachycardia
- Cause: Atria contracting against a closed tricuspid valve.
Mnemonic: "CANNON in CHB" (Cannon waves in Complete Heart Block)
DIAGNOSIS OF JVP
DISORDERS
- ECG → Check for Atrial Fibrillation, Heart Block
- ECHO → Check for Pericarditis, Valve Disease
- Chest X-ray → Check for Heart Failure, Pulmonary Hypertension
Mnemonic: "JVP = 3 E's" (Tests for JVP Problems)
- ECG
- ECHO
- Ex-Ray
TREATMENT OF JVP
DISORDERS
- Heart Failure → Diuretics, ACE Inhibitors, Beta-Blockers
- Pericarditis → NSAIDs, Steroids, Pericardiectomy
- Tricuspid Regurgitation → Valve Surgery
- SVC Obstruction → Stenting, Treat Cause (Tumor, Clot)
Mnemonic: "DRUGS" (Treatment of JVP Problems)
- Diuretics
(For Heart Failure)
- Remove Fluid
(Pericardial Effusion)
- Underlying
Cause (SVC Block, Infection)
- Give Oxygen
(Pulmonary Hypertension)
- Surgery
(Valve Disease, Severe Cases)
FINAL REVISION WITH MNEMONICS
- How to Measure JVP = "JVP = 4 STEPS"
- Differentiate from Carotid = "JVP is JUMPY"
- JVP Waves = "ACXVY"
- Raised JVP = "HF-CT" (Heart Failure, Fluid, Constrictive Pericarditis, TR)
- Kussmaul's Sign = "K for Constrictive Pericarditis"
- Cannon Waves = "CANNON in CHB"
- Diagnosis = "3 E's" (ECG, ECHO, Ex-Ray)
- Treatment = "DRUGS"