Elevated Jugular Venous Pressure

The traditional “window” for viewing the jugular venous pulse is confined to the region of the neck between the clavicle and the angle of the jaw. However, when central venous pressure is markedly elevated, the jugular venous pulse may not be readily visible within that window, even with the patient sitting in the upright position. In such circumstances, be sure to look above the jaw as the pulse is often transmitted by veins of the periauricular area, temple, or forehead.

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Patient 2

This patient has markedly elevated central venous pressure. The unmistakable “inward” movements of the jugular venous pulse are visible in the periauricular area. If the jugular venous pulse cannot be located in the neck, you must always look higher as it is often seen in the periauricular area, the temple, or the forehead.

Periauricular