Jugular vein distention, JVD, also referred to as jugular vein pressure or jugular vein pulsation, typically describes the visible bulging of external veins on either side of the neck. JVD is a rare condition in the United States, affecting less than 200,000 people per year.
The condition is most prevalent in adults but can be seen in children; albeit in remarkably rare conditions. Jugular vein distention acts as an alarm for heart failure and is usually treated as an emergency case when presented to healthcare professionals. This article delves into jugular vein distention, its causes, symptoms, and treatment regimens.
What Is Jugular Vein Distention?
Jugular vein distention occurs when there is a bulge on the external jugular veins. The jugular veins are located on both sides of the neck, close to the skin. The veins carry blood from the head to the main vein of the upper body, also known as the superior vena cava, which then transports the blood to the heart and lungs for oxygenation. Increased pressure in the superior vena cava causes the jugular veins to bulge, causing the veins to appear like a rope or a raised tube just below the surface of the skin. This phenomenon may be caused by heart failure, or a blockage in the superior vena cava, thus causing obstruction of blood flow.
Jugular vein distention is a serious condition as it usually indicates increased central venous pressure (CVP). CVP measures the pressure inside the vena cava and can be an indication of acute heart conditions and vascular diseases. One should seek medical attention immediately and seek emergency services if the condition occurs concurrently with shortness of breath, chest pain, profuse sweating, weakness, fatigue, and labored breathing.
Signs and Symptoms of Jugular Vein
A bulging external jugular vein on the neck is the most common sign of jugular vein distention. This bulge is most visible when a patient lies down straight with the head elevated 45 degrees. The bulging vein may be three to four centimeters. Healthcare professionals diagnose jugular vein distention by turning the patient’s head aside and illuminating the neck area while feeling for pulsations. In a healthy person, the visible jugular vein is usually fully collapsed.
Symptoms that occur alongside jugular vein distention may be crucial in determining the underlying cause of JVD. Elevation of jugular venous pressure is usually a manifestation of an abnormal heart and is often accompanied by the symptoms below:
- Chest pain, pressure, or tightness.
- Rapid heart rate or tachycardia.
- Heart palpitations.
- Increase in urinating frequency; especially at night (nocturia).
- Swelling of the lower extremities especially lower limbs.
- Coughing, wheezing, or choking.
- Blue lips or fingernails, paleness.
- Excessive sweating.
- Rapid weight gain.
- Passing out.
- Shortness of breath.
- Nausea or vomiting.
- Decreased appetite.
- General body weakness.
- Memory loss and confusion.
Causes of Jugular Vein Distention
Jugular vein distention occurs when the central venous pressure increases above the normal threshold. This pressure can be caused by a myriad of health complications as discussed below.
The right muscle of the heart pumps blood to the lungs for oxygenation, while the left muscle pumps the blood out to the body tissues. If the heart fails, then the muscles of the heart have a difficult time pumping blood. Failure of left heart muscles results in accumulation of blood in the lungs, causing the right heart muscles to overwork, and finally, weaken. Consequently, the blood in the vena cava begins to cause a bulge as blood accumulates resulting in jugular vein distention.
Pulmonary hypertension occurs when there is increased blood pressure in the arteries of the lungs due to the narrowing and stiffening of blood vessels. This makes it harder for the heart muscles to pump blood to the lungs. The additional strain causes damage to the muscles on the right side of the heart, causing an increase in pressure on the superior vena cava, and consequently, resulting in jugular vein distention.
Tricuspid Valve Stenosis
Tricuspid valve stenosis is a relatively rare condition that arises from narrowing of the opening of the tricuspid valve, located between the right side and the left side of the heart. When the tricuspid valve is damaged, blood flow through the valve is restricted, causing accumulation of blood in the veins.
Cardiac tamponade describes a situation where fluid leaks from the heart into the pericardium, resulting in a phenomenon known as pericardial effusion. When the pericardial sac fills with fluid, it compresses the heart muscles causing them to work ineffectively, resulting in impeded blood flow.
In some cases, air leaks from the lungs into the chest cavity. This occurrence increases chest pressure which, subsequently, restricts the movement of heart muscles.
Treatment of Jugular Vein Distention
The route of treatment of jugular vein distention highly depends on the cause. The most common causes of JVD are heart complications which are treated via a combination of medication remedies and lifestyle changes:
- Medication given to heart failure patients aims to lower blood pressure. Beta-blockers are commonly prescribed to reduce blood pressure and reduce the level of workload on the heart. Additionally, diuretics control the extra fluid in the blood and thus decrease blood pressure. ACE inhibitors are also used to relieve tension in blood vessels. Patients with ventricular tachycardia are treated with antiarrhythmic medication.
- In addition to medication, a healthy lifestyle is also known to alleviate heart complications. A healthy lifestyle regime includes consistently choosing to eat healthy foods such as whole grain foods, fruits and vegetables, and healthy, plant-based proteins and oils. Incorporating physical exercise into one’s everyday routine as recommended by a doctor, ensuring one has enough sleep, and avoiding emotional stress are examples of recommended remedies for patients with jugular vein distention. Quitting unhealthy habits, such as smoking, alcohol consumption, and binge-eating processed foods also improves heart conditions.
Jugular vein distention arising from other causes is treated on a case by case basis:
- Patients with tricuspid valve stenosis may require valve replacement surgery or surgical repair of the damaged valve to resume normal functioning.
- Additionally, patients with cardiac tamponade are treated via pericardiocentesis, a procedure where a needle is inserted through the pericardium to release pressure from the accumulated fluid.
- Tension pneumothorax is corrected by needle decompression aimed at reducing the chest pressure caused by air.
As jugular vein distention is often a sign of heart failure, getting an early medical assessment, following through with treatment, and keeping a positive outlook are strategies that lead to a better prognosis. It is also vital to follow through with doctors’ appointments and adhere to a healthy lifestyle. Further, if one experiences a bulged vein at the neck, then it is paramount to seek medical attention immediately.