Inspection of the jugular veins requires practice. Fortunately, it possible to hone this skill by studying every examined patient to develop a sense of what is normal.
The A wave of the internal jugular pulse should be sought out in every patient.
Internal jugular waves are more easily distinguished in patients with slow heart rates.
As the patient is approached from the right, the examiner's eyes are trained on the right side of the neck. Internal jugular pulsations sometimes need to be enhanced by tangential lighting directed at the neck to create shadows that make those pulsations more visible.
Once some pulsations are visible, venous neck pulsations must be differentiated from arterial neck pulsations.
Unlike arterial pulses, venous pulses are:
A common mistake is to only look for distention of the external jugular veins rather than at the skin where the internal jugular pulsations are transmitted. Internal jugular pulsations convey information about right atrial and right ventricular mechanical and electrical activity. External jugular distention conveys right atrial pressure.
The A wave of the internal jugular pulse can be identified by palpating the carotid upstroke while looking at the neck. The late diastolic A wave precedes the systolic carotid upstroke.
Therefore, the typical cardiac neck examination begins by palpation of the carotid upstroke with one hand, while the eyes focus on the internal jugular pulsations.
The contents and links on this page were last verified on June 30, 2003.
This information is intended for use by doctors and other healthcare professionals.
Daniel Shindler M.D.