The phrase "go for the jugular" means to attack a vital, vulnerable part of someone or something. It refers to the jugular vein, which runs on both sides of the neck of a person or animal and returns blood from the head to the heart. Serious injury to the jugular can drain blood from the head and brain and lead to a quick death.
For patients with heart disease, cardiologists now often go to the jugular for help in making diagnosis and treatment decisions.
Conventional wisdom has long linked swollen neck veins with the occurrence of heart disease. Nowadays, some cardiologists evaluate blood pressure in the jugular as a part of their physical exams of heart patients and use this information to make their diagnoses. When the blood pressure in the jugular vein is higher than normal, its walls can swell or distend, resulting in a condition known as jugular venous distension.
Cardiologists can estimate the blood pressure in the jugular vein (jugular venous pressure) by careful observation of the vein. This requires the patient to be lying down with the upper body at an angle of less than 30 degrees, with the neck muscles relaxed. The doctor usually observes the jugular vein from the side, aided by a beam of light shining on the patient's neck. From this perspective, he or she can observe the filling level of the jugular and estimate the blood pressure.
Cardiologists can also observe pulses in the jugular vein, called the jugular venous pulse. This is a source of information about the state of the right atrium, one of the chambers in the heart.
Analysis of jugular venous pressure and pulse provides information about physical aspects of the blood circulation in the right side of the heart and can be useful in the diagnosis of different forms of heart and lung disease. An elevated jugular venous pressure is the classic sign of right-sided heart failure.
On the next page, we'll find out what causes jugular venous distension and how it can result in fluid overload.
Jugular Venous Distension and Fluid Overload
Congestive heart failure is a condition in which the heart fails to keep blood moving adequately. As a result, the supply of blood to the body's tissues decreases, lowering efficiency and endurance. With poor circulation, the kidneys fail to remove enough waste products, water and salt from the blood. In addition, the kidneys, because of the decreased blood flow presented to them, retain even more salt and water in an effort to increase blood volume.
The increased blood volume makes more work for the already overworked heart, which may enlarge and beat faster in an attempt to provide the body with oxygen-rich blood. The veins distend with fluid and the blood volume increases.
At the same time, there's a shift in the balance of pressures between fluids inside and outside the blood vessels, which causes fluid that normally stays in the bloodstream to leak into surrounding tissue. This fluid leakage is a primary factor in fluid overload in the lungs, abdomen and/or legs.
For more information about heart failure and its effects on the body, take a look at the links on the next page.
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More Great Links
- Constant J. Using internal jugular pulsations as a manometer for right atrial pressure measurements. Cardiology. 2000;93:26-30.
- Costanzo MR, Guglin ME, Saltzberg MT, et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol. 2007; 49:675-683.
- Costanzo MR, Saltzberg M, O'Sullivan J, et al. Early ultrafiltration in patients with decompensated heart failure and diuretic resistance. J Am Coll Cardiol. 2005;46:2047-2051.
- Devine PJ, Sullenberger LE, Bellin DA, et al. Jugular venous pulse: window into the right heart. South Med J. 2007;100:1022-1027.
- Elkayam U, Hatamizadeh P, Janmohamed M. The challenge of correcting volume overload in hospitalized patients with decompensated heart failure. J Am Coll Cardiol. 2007;49:684-686.
- Mueller C, Frana B, Rodriguez D, et al. Emergency diagnosis of congestive heart failure: impact of signs and symptoms. Can J Cardiol. 2005;21:921-924.
- Rame JE, Dries DL, Drazner MH. The prognostic value of the physical examination in patients with chronic heart failure. Congest Heart Fail. 2003;9:170-175, 178.