Jugular venous pulsations (patient 1)
by Franklin B Saksena, Ranganathan Narasimhan, Sivaciyan Vahe

The Art and Science of Cardiac Physical Examination (With Heart Sounds, Jugular and Precordial Pulsations)

by Narasimhan Ranganathan, Vahe Sivaciyan, Franklin B Saksena
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The head of the patient is at the top of the screen. The internal jugular vein extends underneath the sternomastoid muscle from the bottom of the neck to the angle of the jaw. Its pulsation gets transmitted to the soft tissues and the skin overlying and surrounding the sternomastoid muscle. JVP is recorded in this patient with simultaneous Doppler arterial flow recordings from the radial artery. The beginning of the high frequency swishing noise with each cardiac cycle represents the systolic flow at the radial artery. The sudden downward movement of the jugular is seen to coincide with the systolic flow noise in the Doppler. Note the hollow area between the two heads of the sternomastoid muscle closer to the bottom of the neck becoming dark during systole indicating that the jugular column underneath is falling. This represents the x' descent. Please note that the pulsation seen medial and higher up on the neck rises with the swishing noise. Therefore it is not jugular and is due to the carotid pulsation.

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