Table 5.

Estimation of jugular venous pressure in older adults with heart failure

	Cases					Comments
	1	2	3	4	5
IJV used to estimate JVP?	No	No	No	Yes	No	Transmitted IJV pulsation is most ideal for reliable estimation of JVP but not easily visible in older adults with chronic HF.
EJV used to estimate JVP?	Yes	Yes	Yes	Yes	Yes	EJV contour is visible and its pulsation is more easily visible; a reliable source for JVP estimation.
HJR	No	Yes	Yes	No	No	Not needed for JVP estimation; useful to check for patency of EJV.
Incline needed to make top of jugular pulsation visible in neck	0°	90°	30°	0°	0°	The head of the examination table or bed must be adjusted to make the top of the IJV or EJV pulsation visible in the middle of the neck.
Estimated distance from RA to SA (cm)	5	10	8	5	5	The RA to SA distance is rather fixed and is incline-specific (5, 8, and 10 cm at 0, 30, and 45 incline).36
Estimated distance from SA to jugular pulsation top (cm)	0	10	7	−2	0	The SA to top of jugular pulsation distance is vertical, not horizontal. This is especially important to remember in patients with low JVP (Case 5) who should be in a supine or near-supine position.
Estimated JVP (cm water)	5	20	15	3	5	5–8 cm water normal for most, and up to 10 for some HF patients. A lower JVP may indicate over-diuresis.
How JVP (cm water) was estimated	5 + 0 = 5	10 + 10 = 20	8 + 7 = 15	5-2 = 3	5 + 0 = 5	The vertical SA to top of jugular pulsation distance is added to the incline-specific RA to SA distance to estimate JVP; however, it must be subtracted from the RA to SA distance when JVP is low (Case 5).

Abbreviations: RA, right atrium; SA, sternal angle.