JVP Physical Exam

  • WIPE, blah blah 🙂
  • “Take vital signs”
  • Position: 45°
  • Proper exposure: of the neck
  • General inspection of the pt and surroundings


  • Examine JVP:
    • Position the pt at 45° and turn head to the left
    • Stand right to the pt or at the edge of the bed
    • Look for the jugular between the heads of the sternocleidomastoid, lateral to the carotids


  • How to differentiate between the carotid and jugular?



ž Between SCM heads

ž Non-palpable

ž Can be obliterated

ž Biphasic waves

ž Changes w\ position

ž Drop w\ inspiration

ž Increased w\ hepatojugular reflux

ž Under the medial SCM head

ž Palpable

ž Not obliterated

ž One pulsation

ž Not affected by position

ž Not affected by inspiration

ž Not affected by hepatojugular reflux


  • Measure JVP height:
    • Place a ruler on the sternal angle to measure the top pulse of JVP
    • Normally < 5cm
    • To measure the right heart pressure -> add 5 cm to the JVP


  • JVP waveforms:


Abnormality JVP waveform
Atrial fibrillation Absent ‘a’ waves
AV dissociation (CHB)  Canon ‘a’ waves
TS, PS, pulmonary HTN Large ‘a’ waves
Tricuspid regurgitation Large ‘v’ waves
Constrictive pericarditis Steep ‘y’ waves (Friedreich’s sign)
CHF, fluid overload, SVC obstruction, PE Sustained JVD + normal waveforms


  • Kussmaul’s sign: “Venous pulsus paradoxus”
    • Normally: inspiration -> drop in intrathoracic pressure -> ↑ BF -> JVP ↓
    • Positive Kussmaul’s sign: paradoxical ↑ in JVP during inspiration, indicating poor compliance and filling of the RV
    • Causes: constrictive pericarditis, RV infarct, RH failure, restrictive cardiomyopathy, PE


  • How to differentiate constrictive pericarditis vs cardiac tamponade?



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