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 4

This is a patient with severe tricuspid regurgitation who was admitted to the hospital with decompensated heart failure. She was noted to have markedly elevated filling pressures. This video demonstrates the venous waveform in the patient’s forehead.

Forehead