Shock with Jugular Venous Distention

clinical syndrome that can be readily diagnosed at the bedside by observing hypotension and signs and symptoms of hypoperfusion (eg, mental status changes, weakness, cyanosis, dyspnea, and oliguria). There is a wide range of causes of shock, but few presentations include jugular venous distention (JVD). The common pathophysiology in the differential diagnosis of shock with JVD (Table) is inhibition of right ventricular outflow and/or right ventricular filling. This process translates into decreased right atrial emptying, as manifested by JVD. A systematic approach to the presentation of shock with JVD can prevent unhelpful diagnostic testing and loss of valuable time (Figure 1). An approach that includes a thorough history and physical examination, with echocardiography as an essential diagnostic modality, can differentiate among most underlying problems and help direct an appropriate management plan (Figure 2). This article provides an overview of conditions associated with the presentation of shock and JVD, with a focus on important features of the diagnosis and management of these conditions.