Term
| In the absence of heart valve defects, Central Venous Pressure (CVP) can be correlated with which two heart pressures? |
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Definition
Mean Right Atrial Pressure
and because of their equality during diastole
Filling Pressure of the Right Ventricle (RVEDP) |
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Term
| A neck vein examination identified a decreased amount of stretch on myocardial fibers in the RV prior to contraction, what effect would this finding have on stroke volume? |
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Definition
Stroke volume would decrease due to decreased preload |
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Term
| What number is key when determining a normal (safe) CVP in adults? |
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Definition
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Term
| Jugular Venous Pressure (JVP) is determined using the vertical distance in cm between the top of the jugular venous column of blood in the neck and what cardiac structure? |
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Definition
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Term
| Because clinicians cannot identify the mid right atrium without invasive surgery, what superficial landmark is used to locate it? |
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Definition
Sternal angle of Louis (insertion of 2nd rib on sternum + sternomanubrial joint) |
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Term
| In a supine adult, what is the standard distance between the mid right atrium and the sternal angle? |
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Definition
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Term
| In a sitting/standing adult, what is the distance between the sternal angle and the mid right atrium? |
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Definition
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Term
| What root of the neck structure is used as a reference point when looking for the jugular venous column of blood? |
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Definition
Clavicle
- The distance between the sternal angle and the clavicle is greater than 7 cm, so if the jugular vein protrudes above the clavicle, the JVP examination is positive. |
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Term
| Why is the internal jugular preferred to the external when measuring JVP? |
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Definition
The external jugular could be compressed by facial planes in the neck. |
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Term
| At what distance above the sternal angle would the appearance of the top of the venous column of blood indicate a positive JVP exam? |
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Definition
greater than 3 cm
(5 + 3 = 8, 8>7)
(8 + 3 = 11, 11>7)
etc |
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Term
| A 2nd-year med student went into their OSCII examination and performed a JVP exam on a 52 yr-old patient with CHF. The reading came out to be 12 cm and he reported that the JVP was positive. However, he failed that portion of his exam. What is the most likely reason he failed that part of the physical exam? |
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Definition
The student checked the JVP on the left side of the neck rather than the right.
(Left side is more susceptible to being compressed by other neck structures.) |
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Term
| What can an elevated JVP indicate? |
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Definition
- In the absence of tricuspid stenosis, RVEDP is elevated.
- Common causes
(pulmonary hypertension)
LV systolic or diastolic dysfunction
Chronic lung disease
AND
Cardiac Tamponade/CT constriction
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Term
| Examples of chronic lung diseases are: |
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Definition
Emphesyma, bronchitis, asthma |
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Term
| A 38 year old woman presents with ascites and pitting edema of the ankles. During the patient interview/physical exam, the JVP was normal and her SHx indicated heavy alcohol consumption during her teens and 20's. What is the most likely differential diagnosis (DDx)? |
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Definition
Chronic Liver Disease (low albumin)
Other DDx (excluding alcohol-->potential cirrhosis)
Hypothyroidism
OR
Lymphedema |
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Term
| An elevated JVP that accompanies ascites and pitting edema usually indicates what? |
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Definition
heart failure or pulmonary disease |
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