Jugular vein distention

Introduction When the normal person is standing or sitting, the external jugular vein is not exposed, but the filling is slightly seen in the supine position, but only 2/3 of the distance from the upper edge of the clavicle to the mandibular angle. If the above level or semi-recumbent position is 45 degrees, When the jugular vein is filled, swollen, and full, it is called jugular vein engorgement, indicating that the venous pressure is increased, which is an abnormal phenomenon. The jugular vein is a right atrial pressure gauge that reflects changes in right atrial pressure and volume. Since the right jugular vein is shorter than the left jugular vein and is a direct continuation of the superior vena cava, the right jugular vein reflects the pressure change in the right atrium more than the left side.

Cause

Etiology classification

1. Various organic diseases that cause right heart failure: chronic pulmonary heart disease, pulmonary embolism, congenital heart disease including primary pulmonary hypertension, pulmonary stenosis, positive bstein malformation, Eisenmenger syndrome, rheumatism Sexual heart disease includes tricuspid stenosis and/or tricuspid regurgitation, restrictive cardiomyopathy.

2, mainly for the performance of increased systemic venous pressure. In the semi-recumbent position or sitting position, a filling of the external jugular vein can be seen above the clavicle, and the dry neck reflux sign is positive. When the swollen liver is compressed, the jugular vein filling is intensified, which is an early manifestation of right heart dysfunction. Or other superficial veins can also be seen filling and anger.

3, pericardial disease: pericardial effusion, constrictive pericarditis.

4, superior vena cava syndrome.

an examination

Related inspection

Jugular venous return test, superficial venous filling of the hand, liver-jugular venous return, cervical CT examination, jugular vein examination

First, medical history

The symptoms described by the patient are not only the main clues for judging the presence or absence of jugular vein engorgement, but also provide the main reference for the diagnosis of the cause. Long-term chronic cough with progressive dyspnea is mostly right heart failure caused by pulmonary heart disease; sudden onset, severe chest pain, coughing red bloody sputum, dyspnea that is not commensurate with lung signs, suggesting pulmonary embolism; irregular fever Heart. Patients with dyspnea and pain in the precordial area should consider pericardial effusion and constrictive pericarditis after other infections; young or juvenile onset, shortness of breath, fatigue, palpitations, and shortness of the heart, such as primary pulmonary artery High pressure, pulmonary stenosis, Ebstein malformation, Eisenmenger syndrome, atrial septal defect, etc. Adolescent onset has heart palpitations and difficulty breathing, suggesting restrictive cardiomyopathy, but it is rare. Young and middle-aged onset, a history of rheumatic fever, fatigue after activity, palpitations and abdominal distension, suggesting rheumatic valvular disease, such as tricuspid stenosis and/or regurgitation.

Second, physical examination

Jugular vein engorgement with positive jugular vein pulsation is more common in severe congestive right heart failure with severe tricuspid regurgitation (functional or organic), and the veins of the patient's extremities (such as fingers) are seen with the heart. Contraction systolic pulsation. For jugular vein engorgement without hepatic congestion and/or lower extremity edema, superior vena cava obstruction (superior vena cava syndrome) should be considered.

Third, experimental examination

Pericardial effusion, constrictive pericarditis, and pulmonary heart disease have increased white blood cell counts. The former two also often have rapid erythrocyte sedimentation rate, while the restrictive cardiomyopathy has more obvious leukocytosis, especially eosinophilia. Chronic pulmonary heart disease and pulmonary embolism, abnormal blood gas analysis.

Fourth, equipment inspection

1. The chest X-ray or the radiograph of the X-ray is enlarged to the sides and is in the form of a flask. The heart beats weakly or disappears to indicate the pericardial effusion; the heart shadow is triangular, the pericardium has calcification, suggesting constrictive pericarditis; causing right heart failure All kinds of organic heart disease have a manifestation of right atrial enlargement, but with pulmonary-basal disease, emphysema and right lower pulmonary artery dilation, consider pulmonary heart disease.

2, ECG can detect atrioventricular hypertrophy, myocardial ischemia, conduction block, ectopic rhythm and so on. If there is pulmonary P wave, right ventricular hypertrophy, more common in chronic pulmonary heart disease; SI QIII more suggestive of acute pulmonary embolism; low voltage, alternating line markings with arched back elevations suggest more pericardial effusion; right ventricular hypertrophy And there is right bundle branch block, which can be seen in congenital heart disease.

3. Echocardiography In recent years, echocardiography has a unique position in the diagnosis of certain cardiac causes and pathologies, especially for constrictive pericarditis, pericardial effusion, congenital heart disease, rheumatic heart disease, cardiomyopathy. It can be found that specific changes are one of the important means of diagnosis of heart disease. Doppler and color flow imaging techniques can also selectively observe blood flow disorders in a part of the heart or large blood vessels to diagnose the nature and extent of membrane lesions, as well as congenital cardiovascular malformations.

4, left ventricular angiography restrictive cardiomyopathy can be seen in endocardial fertilizer and cardiac cavity reduction, X-ray selective ventricular angiography, valuable for the diagnosis of congenital heart disease. Cardiac radionuclide ventriculography, using blood pool imaging technology, shows the size of the heart chamber to help identify heart enlargement and pericardial effusion. Radionuclide myocardial sputum helps to identify cardiomyopathy, and has diagnostic value for the nature and location of congenital heart disease shunt, pericardial effusion, and cardiomyopathy.

Differential diagnosis

Jugular vein filling: If the average diastolic pressure gradient exceeds 53 kPa (4 mmHg), the average right atrial pressure can be increased to cause venous congestion, which is characterized by jugular vein filling, hepatomegaly, ascites and edema.

Abdominal wall venous engorgement: In the case of hepatic portal hypertension, the superficial veins of the abdominal wall around the umbilicus may be varicose.

The subcutaneous vein with reticular engorgement is one of the clinical symptoms of thrombophlebitis. The disease is a venous disease characterized by acute non-suppurative inflammation of the vein wall and intraluminal thrombosis. Slow blood flow and eddy current formation, increased blood coagulation and endometrial damage are the main causes. Clinically, it is divided into superficial thrombophlebitis and deep vein thrombosis.

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