Estimating jugular venous pressure (JVP) is a noninvasive method for assessing a patient’s volume status. It is used to estimate whether right atrial pressure (RAP) is high or normal and to assess trends in RAP, including response to treatment.

During your cardiac assessment, you’ll focus on the internal jugular venous pulsations on the patient’s right side to perform the measurement. (Learn the technique for measuring JVP in our Cardiac Assessment Pocket Card.) The normal venous pressure is 1 to 8 mmHg, so while a low value may be consistent with volume depletion, it is not diagnostic since it may also be a normal finding.

Elevated JVP

JVP measured at greater than 3 cm above the sternal angle, or more than 8 cm in total distance above the right atrium, is considered elevated above normal (Bickley et al., 2021).

Heart failure (HF) is a major cause of elevated right heart pressures, so estimating JVP can help diagnose HF or detect exacerbations. Elevation of JVP can also be an important factor in diagnosing or managing other disorders, such as superior vena cava obstruction, tricuspid valve disease, pericardial disease, chronic pulmonary hypertension and cardiac tamponade (Bickley et al., 2021; Meyer, 2021).

Remember…

• The JVP is an estimate of the RAP and is not a direct measure of the left ventricular filling pressures. Interpret abnormal results in conjunction with other findings.
• In obstructive lung disease, the JVP may be elevated on expiration, but the veins collapse on inspiration. This is not indicative of heart failure.

References:
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer Health: Philadelphia.

Meyer, T. (2021, December 3). Examination of the jugular venous pulse. UpToDate. https://www.uptodate.com/contents/examination-of-the-jugular-venous-pulse