Empowering Physical Examination

The estimation of central venous pressure (CVP) by inspection of the neck veins is regarded as a quintessential example of effective bedside cardiovascular examination because it is virtually cost-free and requires minimal time and no equipment. In the upright position, venous drainage from the head occurs primarily through the vertebral veins, allowing the jugular vein to act as a manometer, “collapsing” at a level indicative of the CVP. Sir Thomas Lewis (1) described the examination of the external jugular veins as a method to estimate CVP in 1930 and, since that time, elevated jugular venous pressure (JVP) has demonstrated prognostic importance in heart failure. However, attempts to