Physical Exam

Jugular Venous Pressure

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Video coming September 2026

How to Perform

With the patient reclining at about 30–45° and the head turned slightly away, identify the internal jugular venous pulsation in the neck. Measure the vertical height (in centimeters) from the sternal angle to the top of the pulsation.

How to Interpret

Heart Failure

Elevated jugular venous pressure (>3 cm vertical height above the sternal angle)

Rule in

Helpful

Rule out

Minimally helpful

Evidence:Strong

Hypovolemia

Low jugular venous pressure (estimated CVP at most 5 cm H2O by careful EJV examination, often requiring Trendelenburg positioning)

Rule in

Very helpful

Rule out

Somewhat helpful

Evidence:Limited

Pulmonary Hypertension

Elevated jugular venous pressure (more than 3 cm above the sternal angle)

Rule in

Somewhat helpful

Rule out

Somewhat helpful

Evidence:Limited

Right Ventricular Infarction

Kussmaul sign (paradoxical rise in JVP on inspiration)

Rule in

Helpful

Rule out

Helpful

Evidence:Strong

Volume Overload

Elevated jugular venous pressure (estimated CVP at least 10 cm H2O by careful EJV or IJV examination)

Rule in

Somewhat helpful

Rule out

Somewhat helpful

Evidence:Limited

References

Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 2005;294(15):1944-1956. doi:10.1001/jama.294.15.1944. PMID: 16234501. JAMA Rational Clinical Examination systematic review of 22 studies of adult ED patients with dyspnea. PubMed abstract freely accessible; specific per-finding values widely tabulated in secondary literature. Verified via DARE NBK71447 (NCBI Bookshelf, Centre for Reviews and Dissemination quality-assessed entry, open access) during BedsideDx Scope B audit cascade #38 (2026-05-14): DARE summary reproduces Wang 2005 per-feature pooled LR values exactly. CRD commentary: methods 'appropriate'; conclusions 'likely to be reliable'; two CRD-noted limitations are (i) MEDLINE-only English-only search may have missed relevant studies and (ii) heterogeneity not formally assessed. Neither limitation challenges the headline per-feature pooled LRs.
Roy CL, Minor MA, Brookhart MA, Choudhry NK. Does this patient with a pericardial effusion have cardiac tamponade? JAMA. 2007;297(16):1810-1818. PMID 17456823.
Dubé E, Crozier M, Middleton A, Best B, Ohle R. Kussmaul's sign for the diagnosis of right ventricular myocardial infarction: a systematic review and meta-analysis of diagnostic test accuracy studies. CJEM. 2021;23(2):185-194. doi:10.1007/s43678-020-00012-8. PMID 33709353.
Vinayak AG, Levitt J, Gehlbach B, Pohlman AS, Hall JB, Kress JP. Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients. Arch Intern Med. 2006;166(19):2132-2137. doi:10.1001/archinte.166.19.2132. PMID: 17060544. ClinicalTrials.gov NCT00303355. Free full PDF accessible online.
Shellenberger RA, Imtiaz K, Chellappa N, Gundapanneni L, Scheidel C, Handa R, Bhat A. Physical Examination for the Detection of Pulmonary Hypertension: A Systematic Review. Cureus. 2021 Sep 16;13(9):e18020. doi:10.7759/cureus.18020. PMID: 34692270. PMCID: PMC8523183. Open access, CC BY 4.0.
Lewis T. Remarks on early signs of cardiac failure of the congestive type. Br Med J. 1930;1:849-852.