JVd

Jugular venous distention (JVD) is the visible bulging or pulsation of the jugular veins in the neck, reflecting elevated central venous pressure. It is a sign rather than a disease and is often assessed as an estimate of right atrial pressure. In clinical practice, JVD is frequently discussed alongside jugular venous pressure (JVP), with many sources using the terms interchangeably.

JVD most commonly indicates increased right-sided heart pressures or volume overload. Common underlying causes include congestive heart failure, constrictive or restrictive pericarditis, cardiac tamponade, massive pulmonary embolism, right ventricular infarction, and severe tricuspid regurgitation. It may also occur with obstruction of the superior vena cava. JVD is typically not prominent in dehydration or hypovolemia.

Assessment and measurement are usually performed with the patient in a semi-erect position, typically at 30 to 45 degrees. The clinician looks for the highest point of venous pulsation in the neck and measures its vertical height above the sternal angle (the Angle of Louis). Normal JVP is about 3 cm or less above the sternal angle; higher measurements suggest elevated central venous pressure. The assessment should distinguish venous pulsations from the carotid artery and note any characteristic waveform features, such as prominent v waves in tricuspid regurgitation.

Evaluation of JVD involves identifying the underlying cause through history, examination, and often imaging such as echocardiography. Management targets the root issue—diuresis for volume overload, urgent intervention for tamponade or SVC obstruction, and appropriate treatment for heart failure or other cardiac conditions.