Clinical features

• Use a well-lit room; lay the patient at 30° to 45° to horizontal; turn the head and look for the right internal jugular vein. Raise or lower the patient as required (normal patients may need to be laid almost flat). The JVP is the vertical height from the highest point of the pulsation to the angel of Louis.

Why?

A raised jugular venous pressure makes an elevated central venous pressure more likely

Patient	Target Disorder and Reference Standard	Diagnostic Test	LR+ (95% CI)	Post-test Probability
suspected heart failure b (pre-test probability: 31%)	elevated central venous pressure (central venous pressure > 5 cm)	JVP high	4.1 (1.3 to 13)	65%
		JVP normal	0.8 (0.5 to 1.3)	26%
		JVP low	0.2 (0.02 to 1.3)	8%

A raised jugular venous pressure makes left ventricular failure more likely

Patient	Target Disorder and Reference Standard	Diagnostic Test	LR+ (95% CI)	Post-test Probability	LR- (95% CI)	Post-test Probability
suspected heart failure b (pre-test probability: 17%)	left ventricular systolic failure (echocardiogram)	jugular venous distension	9.3 (2.9 to 30)	64%	0.84 (0.73 to 0.97)	14%

Note:

• Physicians agree only moderately about the position of the JVP. ^b