0
February 28, 1996, Vol 275, No. 8 >
ARTICLE | February 28, 1996

Does This Patient Have Abnormal Central Venous Pressure? FREE

Deborah J. Cook, MD, FRCPC, MSc (Epid); David L. Simel, MD, MHS
[+] Author Affiliations

Reprint requests to Department of Medicine, Division of Critical Care, St Joseph's Hospital, 50 Charlton Ave E, Hamilton, Ontario, Canada L8N 4A6 (Dr Cook).

The Rational Clinical Examination section editors: David L. Simel, MD, MHS, Durham Veterans Affairs Medical Center and Duke University Medical Center, Durham, NC; Drummond Rennie, MD, Deputy Editor (West), JAMA.


JAMA. 1996;275(8):630-634. doi:10.1001/jama.1996.03530320054034
Text Size: A A A
Published online
Article
References

A 65-YEAR-OLD woman has had dyspnea for 2 months. She has had to give up her hobby of hiking and is now short of breath climbing even one flight of stairs. Her dyspnea is sometimes worse at night. She has no chest pain, cough, or sputum, and the review of systems is otherwise negative. On physical examination, her blood pressure is 135/90 mm Hg, and she has a regular cardiac rhythm at a rate of 72 beats per minute. You turn your attention to the jugular veins and next ask yourself, "Does this patient have abnormal central venous pressure?"

WHY IS THIS QUESTION IMPORTANT?  Evaluation of the jugular venous pulse provides important information about pressure and other hemodynamic events in the right atrium.1-3 Via the former, it provides a useful estimate of central venous pressure (CVP) and thus the patient's intravascular volume status. Inspection of the waveforms can assist

REFERENCES

1 +
Braunwald E.  The physical examination.  In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine . Philadelphia, Pa: WB Saunders; 1988;:13-40.
2 +
O'Rourke RA.  The measurement of systemic blood pressure, normal and abnormal pulsations of the arteries and veins.  In: Hurst JW, Schlant RC, eds. The Heart, Arteries and Veins . New York, NY: McGraw Hill; 1989;:157-162.
3 +
Davison R, Cannon R.  Estimation of central venous pressure by examination of the jugular veins. Am Heart J . 1974;;87:279-282.
4 +
Cook DJ.  The clinical assessment of central venous pressure. Am J Med Sci . 1990;;299:175-178.
5 +
Connors AF, McCaffree DR, Gray BA.  Evaluation of right heart catheterization in the critically ill patient without acute myocardial infarction. N Engl J Med . 1983;;308:263-267.
6 +
Briscoe CE.  A comparison ofjugular and central venous pressure measurements during anesthesia. Br J Anaesth . 1973;;45:173-177.
7 +
Stoelting RK.  Evaluation of external jugular venous pressure as a reflection of right atrial pressure. Anesthesiology . 1983;;38:291-294.
8 +
Davison R, Cannon R.  Estimation of central venous pressure by examination of jugular veins. Am Heart J . 1974;;87:279-282.
9 +
Matthews MB.  The cardiovascular system.  In: MacLeod J, ed. Clinical Examination . Edinburgh, Scotland: Churchill Livingstone; 1982;:99-146.
10 +
Ducas J, Magder S, McGregor M.  Validity of the hepatojugular reflux as a clinical test for congestive heart failure. Am J Cardiol . 1983;;52:1299-1303.
11 +
Pasteur W.  Note on a new physical sign of tricuspid regurgitation. Lancet . 1885;;2:524.
12 +
Cohn JN.  Central venous pressure as a guide to volume expansion. Ann Intern Med . 1964;;66:1283-1287.
13 +
Ewy GA.  The abdominojugular test: technique and hemodynamic correlates. Ann Intern Med . 1988;; 109:456-460.
14 +
Constant J, Lippschutz EJ.  The one minute abdominal compression test or 'the hepatojugular reflux,' a useful bedside test. Am Heart J . 1964;; 67:701-707.
15 +
Singh SP, Haider R.  The lack of value of hepatojugular reflux as a sign of heart failure. Postgrad Med J . 1973;;49:10-13.
16 +
Burch GE, Ray CT.  Mechanism of the hepatojugular reflux test in congestive heart failure. Am Heart J . 1954;;48:373-382.
17 +
Matthews MB, Hampson J.  Hepatojugular reflux. Lancet . 1958;;1:873-876.
18 +
Eisenberg PR, Jaffe AS, Schuster DP.  Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med . 1984;;12:549-553.
19 +
Simel DL, DeLong ER, Feussner JR, Matchar DB.  Intermediate, indeterminate, and uninterpretable diagnostic test results. Med Decis Making . 1987;;7:107-114.
20 +
Marantz PR, Kaplan MC, Alderman MH.  Clinical diagnosis of congestive heart failure in patients with acute dyspnea. Chest . 1990;;97:776-781.
21 +
Maisel AS, Atwood JE, Goldberger AL.  Hepatojugular reflux: useful in the bedside diagnosis of tricuspid regurgitation. Ann Intern Med . 1984;;101: 781-782.
22 +
Sapira JD.  Veins.  In: Sapira JD, ed. The Art and Science of Bedside Diagnosis . Baltimore, Md: Williams & Wilkins; 1990;:355-370.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Braunwald E.  The physical examination.  In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine . Philadelphia, Pa: WB Saunders; 1988;:13-40.
2 +
O'Rourke RA.  The measurement of systemic blood pressure, normal and abnormal pulsations of the arteries and veins.  In: Hurst JW, Schlant RC, eds. The Heart, Arteries and Veins . New York, NY: McGraw Hill; 1989;:157-162.
3 +
Davison R, Cannon R.  Estimation of central venous pressure by examination of the jugular veins. Am Heart J . 1974;;87:279-282.
4 +
Cook DJ.  The clinical assessment of central venous pressure. Am J Med Sci . 1990;;299:175-178.
5 +
Connors AF, McCaffree DR, Gray BA.  Evaluation of right heart catheterization in the critically ill patient without acute myocardial infarction. N Engl J Med . 1983;;308:263-267.
6 +
Briscoe CE.  A comparison ofjugular and central venous pressure measurements during anesthesia. Br J Anaesth . 1973;;45:173-177.
7 +
Stoelting RK.  Evaluation of external jugular venous pressure as a reflection of right atrial pressure. Anesthesiology . 1983;;38:291-294.
8 +
Davison R, Cannon R.  Estimation of central venous pressure by examination of jugular veins. Am Heart J . 1974;;87:279-282.
9 +
Matthews MB.  The cardiovascular system.  In: MacLeod J, ed. Clinical Examination . Edinburgh, Scotland: Churchill Livingstone; 1982;:99-146.
10 +
Ducas J, Magder S, McGregor M.  Validity of the hepatojugular reflux as a clinical test for congestive heart failure. Am J Cardiol . 1983;;52:1299-1303.
11 +
Pasteur W.  Note on a new physical sign of tricuspid regurgitation. Lancet . 1885;;2:524.
12 +
Cohn JN.  Central venous pressure as a guide to volume expansion. Ann Intern Med . 1964;;66:1283-1287.
13 +
Ewy GA.  The abdominojugular test: technique and hemodynamic correlates. Ann Intern Med . 1988;; 109:456-460.
14 +
Constant J, Lippschutz EJ.  The one minute abdominal compression test or 'the hepatojugular reflux,' a useful bedside test. Am Heart J . 1964;; 67:701-707.
15 +
Singh SP, Haider R.  The lack of value of hepatojugular reflux as a sign of heart failure. Postgrad Med J . 1973;;49:10-13.
16 +
Burch GE, Ray CT.  Mechanism of the hepatojugular reflux test in congestive heart failure. Am Heart J . 1954;;48:373-382.
17 +
Matthews MB, Hampson J.  Hepatojugular reflux. Lancet . 1958;;1:873-876.
18 +
Eisenberg PR, Jaffe AS, Schuster DP.  Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med . 1984;;12:549-553.
19 +
Simel DL, DeLong ER, Feussner JR, Matchar DB.  Intermediate, indeterminate, and uninterpretable diagnostic test results. Med Decis Making . 1987;;7:107-114.
20 +
Marantz PR, Kaplan MC, Alderman MH.  Clinical diagnosis of congestive heart failure in patients with acute dyspnea. Chest . 1990;;97:776-781.
21 +
Maisel AS, Atwood JE, Goldberger AL.  Hepatojugular reflux: useful in the bedside diagnosis of tricuspid regurgitation. Ann Intern Med . 1984;;101: 781-782.
22 +
Sapira JD.  Veins.  In: Sapira JD, ed. The Art and Science of Bedside Diagnosis . Baltimore, Md: Williams & Wilkins; 1990;:355-370.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...

JAMAevidence
© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems