To the Editor: Observing jugular venous pressure (JVP) is central to cardiovascular examination. Lewis, in 1930,1 was the first to report the use of the external jugular vein as a manometer for recording pressure in the right atrium. Unfortunately, some textbooks on clinical examination and many clinical teachers incorrectly state that the external jugular is unreliable for measuring JVP and that only the internal jugular should be used. The problem with this is that the internal jugular vein is located deep within the neck, where it is covered by the sternomastoid muscle and is therefore not usually visible.
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- University of Queensland, Brisbane, QLD.
- 1. Lewis T. Remarks on early signs of cardiac failure of the congestive type. Br Med J 1930; 1: 849-852.
- 2. Seth R, Magner P, Matzinger F, van Walraven C . How far is the sternal angle from the mid-right atrium? J Gen Intern Med 2002; 17: 861-865.
- 3. Parker JL, Flucker CJ, Harvey N, et al. Comparison of external jugular and central venous pressures in mechanically ventilated patients. Anaesthesia 2002; 57: 596-600.
- 4. Butman SM, Ewy GA, Standen JR, et al. Bedside cardiovascular examination in patients with severe chronic heart failure: importance of rest or inducible jugular venous distension. J Am Coll Cardiol 1993; 22: 968-974.