Venous Pressure 1

Venous Pressure Venous Pressure generally refers to the average pressure within venous compartment of circulation Blood from all the systemic veins flows into the right atrium of the heart, therefore the pressure in the Rt atrium called Central Venous pressure 2

Factor affecting CVP Cardiac output Respiratory Activity Contraction of Skeletal muscles (leg & abdominal muscles). Sympathetic Vasoconstrictor tone Gravity All these affect CVP by either changing venous blood volume or venous compliance

How to measure the CVP ?? Direct: by catheter introduced into large thoracic veins Indirect: Is estimated from Jugular venous pressure 5

Jugular Venous Pulse (JVP) There is no valves between the Rt atrium and the Internal Jugular Vein . So the degree of distension of this vein is detected by the Rt atrium pressure. Pressure changes transmitted from right atrium The right internal jugular is the best neck vein to inspect Provides information about hemodynamic changes in right atrium & ventricle 6

Anatomy Of IJV 7

Cont…. The internal jugular vein is lateral to carotid artery & deep to sternomastoid muscle. External jugular is superficial to sternomastoid 8

JVP waves 9

Cont…. A a positive wave due to atrial contraction. C a positive deflection due closure of tricuspid (carotid pulsation) X a negative deflection due to atrial relaxation V a positive deflection due to filling of the right atrium against the closed tricuspid valve during ventricular contraction (venous return) Y a negative deflection due to emptying of the right atrium upon ventricular relaxation 11

Abnormalities of wave Prominent ‘a’ wave : Right atrial and right ventricular hypertrophy (due to P.HTN or P.stenosis) Tricuspid stenosis. Cannon wave: Large ‘a’ wave produce when Rt atrium contract against closed tricuspid valve. This seen in complete heart block 12

Cont… Kussmaul sign: A paradoxical rise of JVP on inspiration. Causes: Constrictive pericarditis Cardiac tamponade Sever Rt ventricular failure 13

Difference between arterial and venous pulsation in neck Change in posture ? Change in respiration ? Abdomino-jugular reflux ? Pulsation pattern ? Palpation ? Occlusion ? 14

How measure JVP ? LOOK CONFIRM MEASURE 16

Method Position 45 degree Rest the pt head on pillow to ensure neck muscle relax, and slightly tilted toward the left side. look acorss the neck from the Rt side of the pt. Identify the Jugular vein Confirm the pulse. 18

Cont.. Identify the upper limit of venous pulsation JVP is measured by two pencils method Place one pencil at sternal angle vertical to ground & other pencil at upper limit of venous pulsation horizontal to the ground Measure length of the vertical pencil in cm btw the sternal angle & where it is crossed by the horizontal pencil. Normal JVP up to 3 cm 19

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raised JVP

Causes of raised JVP Right heart failure Constrictive pericarditis Superior vena cava obstruction Pericardial effusion Cardiac tamponade Tricuspid valve disease 23

Cardiac tamponade Cardiac tamponade: the accumulation of fluid in the pericardium in an amount sufficient to cause serious obstruction to the inflow of blood to ventricle results in cardiac tamponade. The three principal features of tamponade are: 1.elevation of intracardiac pressures 2.limitation of ventricular fillng 3.reduction of cardiac output

Beck triad: increased jugular venous pressure Hypotension diminished heart sounds

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