Jugular venous pressure and the venous pulse !

Exam technique

The height of the pulsation in the neck vein estimates the pressure inside the right heart, with no needles.

Updated 2026-11-01

See it in 3D: Internal jugular vein · External jugular vein · Right atrium · Superior vena cava · Sternum

What it is

The right internal jugular vein works as a manometer of the right atrium. Its height above the sternal angle estimates central venous pressure, and its waveform reports on rhythm, the tricuspid valve and the pericardium. It is key in heart failure, volume status and tamponade.

Landmark anatomy

The right internal jugular runs straight to the superior vena cava and right atrium, with no valves breaking the column.
The sternal angle sits about 5 cm above the right atrium at any incline, which is why it is the reference point.
The external jugular is easier to see but less reliable: it has valves and kinks.
a wave: atrial contraction. x descent: atrial relaxation. v wave: atrial filling with the tricuspid closed. y descent: tricuspid opening.

Technique, step by step

Lay the patient with the head of the bed at 30–45 degrees, head supported and turned slightly to the left, neck relaxed.
Light the neck tangentially and look for the right internal jugular pulsation, between the two heads of the sternocleidomastoid or behind it.
Tell it from the carotid: the venous pulse has two waves, is not palpable, collapses with light pressure at the base of the neck and falls on inspiration.
Find the top of the pulsation and measure the vertical distance to the sternal angle with one ruler and a horizontal straight edge.
Adjust the bed until the top is visible: sit the patient up if pressure is very high, lower the bed if it is low.
Watch the change with inspiration (it should fall) and, if needed, test hepatojugular reflux.

Abnormal findings

Normal: top at 3–4 cm or less above the sternal angle. Higher: right-sided or biventricular heart failure, volume overload, tamponade, constrictive pericarditis, pulmonary hypertension.
Flat neck veins lying supine: hypovolemia.
Kussmaul sign (pressure rises on inspiration): constrictive pericarditis, restrictive cardiomyopathy, right ventricular infarction.
Cannon a waves: atrioventricular dissociation (complete heart block, ventricular tachycardia). Absent a wave: atrial fibrillation.
Large v waves: tricuspid regurgitation. Distension without pulsation: superior vena cava obstruction.

Common errors

Mistaking the carotid for the jugular.
Measuring from the clavicle or earlobe instead of the sternal angle.
In obesity and short necks the estimate is unreliable; ultrasound of the vena cava helps.

Test yourself

Think of the answer, then tap the question to see it.

From which landmark is jugular venous pressure measured?

From the sternal angle, measuring the vertical distance to the top of the internal jugular pulsation.

How is the jugular pulsation told from the carotid pulse?

The venous pulse has two waves, is not palpable, collapses with light pressure, falls on inspiration and changes with posture.

What is the Kussmaul sign and what does it suggest?

A rise in jugular pressure on inspiration; it suggests constrictive pericarditis, restrictive cardiomyopathy or right ventricular infarction.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

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Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: 24.3 Nursing Assessment - Clinical Nursing Skills | OpenStax (OpenStax (Rice University), 2024); Heart failure: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026); Cardiac tamponade: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026).

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Representative model, for educational purposes only.