Download Jugular veins

Jugular veins
Anatomy:
External jugular vein: extends from the angle of the
mandible downwards and obliquely superficial to the
sternomastoid till the apex of the posterior triangle
where it pierces the platysma and deep fascia to join
the internal jugular vein.
Internal jugular vein: descends lateral to the carotid
behind the medial edge of the stenomastoid muscle.
Jugular venous pressure:
Pressure in the jugular veins reflects right atrial
pressure. It is best estimated from the internal
jugular veins. If not seen, the external jugular
veins could be used. However, it is less reliable.
To determine the level of venous pressure find
the highest point of oscillations in the internal
jugular veins or the point above which the
external jugular vein appear collapsed.
Jugular venous pressure
in a healthy subject
The reference point for
estimating the venous
pressure is the sternal
angle. This is because the
sternal angle is roughly 5
cm above the mid-right
atrium, regardless of the
patient's position (supine
or sitting upright).
Venous pressure is
measured in vertical
distance for it.
Jugular venous pulsations:
It reflects the sequence of pressure changes
within the right atrium. The venous pulse has 3
components; the a, c and v waves.
“a” wave: due to atrial contraction. It occurs just
before the first heart sound
“c” wave: transmitted from the carotid artery.
“v” wave: occurs while the tricuspid valve is shut.
It is associated with atrial filling (venous return)
The fall in the venous pressure after the "a" wave
is called the "x" descent & that after "v" wave is
called the "y" descent.
Differences between atrial and
venous pulsations:
Carotid
1 peak per heart beat
Jugular
2 peaks per beat
Palpable
Impalpable
Independent of
respiration
Varies with respiration
(falls with inspiration)
independent of position
Varies with position of
the patient
Examination sequence:



Position of the patient reclining supine at 45° in
good light
Ensure that the neck muscles are relaxed by
resting the back of the head on a pillow
Look across the neck from the right side of the
patient


Identify the internal jugular pulsations
Estimate the vertical height in cm between the
top of the venous pulsation and the sternal
angle to give the venous pressure.
Abnormalities of the jugular veins:
Congested and
pulsating:




Heart failure
Pericardial effusion
Constrictive
pericarditis
Pulmonary embolism
congested and non-pulsating:

superior vena caval obstruction
Abnormalities of jugular veins wave
form:

Absent a waves in atrial fibrillation

Prominent a wave in pulmonary hypertension

Prominent v wave in tricuspid regurge