Why is the measurement of jugular venous pressure discredited?
Every doctor should be able to make a probable diagnosis of congestive heart failure by clinical examination. The most revealing clinical sign is an elevated jugular venous pressure. The measurement of this pressure was introduced by Lewis in 1930 and refined and standardised by Borst and Molhuysen in 1952. Still, this method has fallen into disuse and is thought to be not very sensitive for diagnosing congestive heart failure. A study of the methods described in the literature reveals that variations in technique are responsible for great differences in normal values. It is argued that smaller elevations of jugular venous pressure can only be measured reliably by adhering strictly to the conditions put forward by Borst and Molhuysen. In this way the sensitivity will improve considerably. A plea is made for an intensive training in this method for doctors and medical students.
University Medical Centre St Radboud, Nijmegen, The Netherlands, vtlaar@tiscali.nl
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van't Laar
D001795:Blood Pressure Determination / Q000379:methods / Q000592:standards*; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007601:Jugular Veins / Q000503:physiopathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014690:Venous Pressure / Q000502:physiology