Physical Exam

Neck Vein Inspection

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Video coming September 2026

How to Perform

With the patient reclining at about 30 to 45 degrees, the head turned slightly away, and the neck muscles relaxed, use tangential lighting to inspect the internal jugular venous pulsations low in the neck. Identify the venous pulsation — distinguished from the carotid by its soft, undulating, multiphasic character that is not palpable and that varies with respiration and position — and note the height of the venous column and its waveform.

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

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.
McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.