Jugular vein distention (JVD) is the abnormal elevation and fullness of the internal or external jugular veins, reflecting increased central venous pressure (CVP). It is commonly assessed with the patient in a supine position with the head elevated 30–45°. Distention more than 3–4 cm above the sternal angle is considered abnormal.

Pathophysiology

• JVD reflects elevated right atrial pressure, which can result from:

  • Right-sided heart failure

  • Tricuspid valve disease (stenosis or regurgitation)

  • Constrictive pericarditis

  • Cardiac tamponade

  • Superior vena cava obstruction

• Increased venous pressure causes engorged veins, hepatomegaly, ascites, and peripheral edema.

Clinical significance

• A visible JVD is a reliable marker of fluid overload and right heart dysfunction.

• It is often an early or late indicator depending on the underlying condition:

  • Early in SVC obstruction, constrictive pericarditis

  • Late in left-sided heart failure progressing to right-sided failure

History & symptom assessment

Ask the patient about:

• Onset, duration, and severity of swelling in the neck

• Symptoms of heart failure: dyspnea, orthopnea, paroxysmal nocturnal dyspnea

• Edema: ankles, legs, sacrum

• Rapid weight gain

• Fatigue, anorexia, nausea, vomiting

• History of cardiac, pulmonary, hepatic, or renal disease

• Medication history (e.g., diuretics, fluid intake)

Physical examination

1. Patient Positioning

   • Supine with head elevated 30–45° (up to 90° for more severe cases)

2. Identifying JVD

   • Locate sternal angle (angle of Louis) as reference

   • Observe internal jugular vein pulsations

   • Differentiate from carotid artery:

     • Venous pulsations: non-palpable, vary with respiration, obliterate with light pressure

     • Arterial pulsations: palpable, constant, unaffected by pressure

   • Measure vertical height from sternal angle using a ruler

   • 3–4 cm above sternal angle = distention

3. Associated Findings

   • Peripheral edema, hepatomegaly, ascites

   • Lung crackles, heart gallop, pericardial friction rub

   • Hypotension, tachycardia, cyanosis (if acute or severe)

Emergency interventions

• If JVD occurs with pale, clammy skin, dyspnea, hypotension, suspect cardiac tamponade

• Immediate steps:

  • Elevate the patient’s legs 20–30°

  • Administer supplemental oxygen

  • Monitor vital signs, oxygen saturation, cardiac rhythm

  • Establish IV access

  • Prepare for pericardiocentesis if indicated

• For heart failure with JVD:

  • Administer diuretics

  • Restrict fluids if hypervolemic

  • Monitor weight, intake/output, renal function

Medical causes

Investigations

• Echocardiography: assess right atrial pressure and cardiac function

• Chest X-ray: cardiomegaly, pulmonary congestion

• Electrocardiogram (ECG): detect arrhythmias, ischemia

• Blood tests: BNP, renal function, electrolytes, liver enzymes

• CT or MRI: if SVC obstruction suspected

• Hemodynamic monitoring: Central venous pressure (CVP) via catheter in severe cases

Special considerations

• Pediatric patients: JVD is difficult to assess due to short neck; rely on peripheral edema, hepatomegaly, and other signs

• Daily monitoring of weight and fluid balance is crucial

• Avoid rapid fluid administration in patients with severe JVD

Patient counseling

• Educate on dietary sodium restriction and fluid management

• Teach daily weight monitoring and reporting sudden weight gain or swelling

• Explain symptoms requiring urgent medical attention, e.g., dyspnea, chest pain, severe edema

• Encourage scheduled rest and activity balancing

Prognosis

• Persistent JVD indicates chronic right-sided heart dysfunction

• Acute JVD with hypotension may signal life-threatening conditions (tamponade, massive heart failure)

• Monitoring trends helps guide therapy effectiveness and disease progression

References

1. Nikolaou, M., Parissis, J., Yilmaz, M. B., et al. (2013). Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. European Heart Journal, 34, 742–749.

2. Raurich, J. M., Llompart-Pou, J. A., Ferreruela, M., et al. (2011). Hypoxic hepatitis in critically ill patients: Incidence, etiology and risk factors for mortality. Journal of Anesthesia, 25, 50–56.