Abstract

“From a careful observation of the jugular pulsation in the neck and careful auscultation over the precordia, there is seldom much doubt as to the presence or absence of tricuspid regurgitation.” - —Sir William Osler

Dr. Devine et al² are to be applauded for this eloquent review of the jugular venous pulse (JVP); they have masterfully explained the mechanisms for the various alterations of this clinical finding. I further share the authors’ concern that many clinicians have forgotten or ignored the wealth of information to be gleaned from this simple bedside examination. As the title implies, the JVP, owing to its proximate and direct connection to the right heart, is perhaps the most direct external manifestation of the heart. When examined carefully, the JVP can provide a wealth of information regarding the filling and pulmonary arterial pressures. For instance, alterations of the C- and V-waves can clue the examiner into possible mitral and tricuspid regurgitations. In addition, the accuracy of the right JVP may be one reason the physical examination is traditionally conducted from the right side.