Technique is to get the patient to lie back at 45 degrees to the horizontal with the head turned slightly to the left with the head on a pillow so the sternomastoid are relaxed.
The lack of one-way valves between the internal jugular and Right atrium suggests it may be used as a manometer of right atrial pressure. Examination of the internal jugular vein can take some practice but can give some clues to right-sided filling pressures. It is located between the heads of the sternomastoid.
Best seen at an angle with light glancing off. Very high levels seen from the end of the bed as the earlobes move with a pulse. Do not confuse with the more superficial external jugular vein which has valves and is a poor marker of right atrial pressure.

Differentiating JVP and Carotid pulse
Carotid is readily palpable. JVP isn't Carotid has one main waveform, JVP multiple Only the JVP varies with posture and respiration JVP pulsation can be occluded by pressure above Pressure on the abdomen can cause a temporary rise in JVP

Inspecting the Jugular venous pulse

Measure the height by calculating the vertical height above the sternal notch which approximates to the right atrium.
If the JVP is not pulsatile then consider SVC obstruction - other veins are often dilated on the chest wall and the face and conjunctiva suffused
JVP usually falls on inspiration, if it rises consider pericardial tamponade or constrictive pericarditis

JVP Waveform

'a' wave: atrial systole - lost with AF. Increased with pulmonary hypertension/stenosis and RVH.
'c' wave: carotid artefact
'v' wave: atria fills while tricuspid valve shut
'x' descent: RAP falls during ventricular systole
'y' descent: Sharp y descent in constrictive pericarditis

Pathological JVP waveforms

Cannon 'a' wave - Complete heart block or VT or frequent Ventricular ectopics where atria may contract against a closed Tricuspid valve.
Pathological giant "V" wave which is different to "v" waves is a composite of both a and the v wave seen with right ventricular systole and Tricuspid regurgitation

Causes of a raised JVP

Congestive cardiac failure (LHF+RHF)
Right sided failure - Inferior MI
Increase in Inspiration (Kussmaul's sign) - Constrictive pericarditis and tamponade
Pulmonary embolism
Cardiac tamponade
Pericardial effusion
Constrictive pericarditis
IV Fluids and overhydration
Superior venal caval obstruction (NON Pulsatile

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Jugular Venous pressure

Jugular Venous pressure

Inspecting the Jugular venous pulse

JVP Waveform

Pathological JVP waveforms

Causes of a raised JVP

Categories