JVP Waveform Analysis

Neck venous pulsation gives two related pieces of information: the height of the column estimates right-sided filling pressure, and the waveform contour shows how the right atrium, right ventricle, tricuspid valve, and pericardium behave during the cardiac cycle. The internal jugular vein has no intervening valve between it and the right atrium, making it a direct bedside window into right atrial pressure. Read the examination in sequence. First establish the height of the venous column; then confirm that the motion is venous rather than carotid; finally match the waves with the ECG, carotid pulse, respiration, blood pressure, and overall perfusion. A waveform abnormality is a clue to mechanism, not a diagnosis in isolation. An elevated JVP may reflect heart failure, right ventricular pressure or volume overload, pericardial disease, acute obstruction to pulmonary flow, or a non-cardiac cause such as superior vena cava obstruction.