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 3

This patient was admitted to the hospital with decompensated heart failure. She had long-standing heart failure and her body had adapted to markedly elevated filling pressures. These videos demonstrate the venous waveform in the region of the patient’s temple. Many of the doctors who evaluated her reported that they could not find the jugular venous pulse.

This patient also has an “ejection rattle” from a Starr-Edwards prosthetic valve in the aortic position.

Temple