Jugular vein distention occurs when the pressure inside the vena cava increases and appears as a bulge running down the right side of a person's neck.
In this article, we look at the causes of jugular vein distention (JVD), additional symptoms, and how it is treated.
A person has jugular veins on both sides of their neck. They act as passageways for blood to move from a person's head to the superior vena cava, which is the largest vein in the upper body. The superior vena cava then transports the blood to the heart and lungs.
The blood flow from the head to the heart is measured by central venous pressure or CVP.
Jugular vein distention or JVD is when the increased pressure of the superior vena cava causes the jugular vein to bulge, making it most visible on the right side of a person's neck.
The appearance of the vein is similar to a rope or raised tube below the surface of the skin, and its height can be measured to indicate the CVP.
An increased volume of blood and high CVP are signs of heart failure. However, there are other reasons why JVD might occur, such as a blockage.
There are several reasons why JVD may occur, including:
- Right-sided heart failure. The right ventricle of the heart is responsible for pumping blood to the lungs to collect oxygen. The left ventricle is responsible for pumping the blood out to the rest of the body. People with right-sided heart failure have usually already experienced left-sided heart failure. The blood accumulation in the lungs caused by left ventricle failure means the right ventricle has to work harder and becomes weakened until it cannot pump effectively anymore. This failure causes the veins to bulge as blood accumulates.
- Pulmonary hypertension. This condition occurs when the pressure in blood vessels becomes dangerously high, causing their walls to thicken and stiffen, meaning less blood can pass through. This can damage the right side of the heart and increase pressure in the superior vena cava.
- Tricuspid valve stenosis. This is caused by a stiffening of the valve that separates the right atrium and the right ventricle of the heart. This results in blood backing up in the veins.
- Superior vena cava obstruction. Superior vena cava obstruction can occur if a tumor growing in the chest or a clot in the superior vena cava restricts blood flow in the vein.
- Constrictive pericarditis. If the pericardium or the fluid-filled sac around the heart becomes stiff, it can prevent the chambers of the hearts from filling up with blood properly. This situation can cause the blood to back up in the veins.
- Cardiac tamponade. This is a condition that occurs when the sac around the heart fills up with fluid and no longer allows the heart to fill with blood properly. This can happen for a variety of reasons, including infection and bleeding. It causes heart failure as well as JVD.
As well as the appearance of a bulging jugular vein, other symptoms may occur in a person with JVD. These additional symptoms can help determine the underlying cause of JVD.
Some symptoms that may occur alongside JVD are considered an emergency and require immediate medical attention. These symptoms include:
- excessive sweating
- blue lips or fingernails
- decreased alertness
- passing out or becoming unresponsive
- chest pain, tightness, or pressure
- heart palpitations
- not being able to produce any urine
- rapid heart rate or tachycardia
- rapid weight gain
- shortness of breath or difficulty breathing
- wheezing or choking
Other symptoms that may occur alongside JVD are:
- memory loss
- feeling fatigued
- swelling, especially of the lower extremities
- increased need to urinate at night, known as nocturia
- a decrease in appetite
- changes in weight
- shortness of breath or rapid breathing, known as tachypnea
JVD can be the sign of a severe condition, including heart failure, so it is vital that a person is seen by a medical professional as soon as possible.
While heart failure can happen to anyone, risk factors for heart failure include:
- high blood pressure
- congenital heart defects
- heart attack
- alcohol use or abuse
- coronary artery disease
- some medications
- sleep apnea
- irregular heartbeats
Complications, including with a person's circulation, can occur alongside JVD and may result in fatigue. They can also cause cognitive or memory difficulties, as well as potential liver and kidney problems.
The appearance of a bulging vein in a person's neck is enough to diagnose them with JVD. However, determining the underlying cause usually requires further testing.
To find out if there is any immediate cause for concern, a doctor can estimate a person's CVP by measuring the height of the bulge.
This measurement will be taken when a person is lying down with their head elevated at an angle of 45–60 degrees.
If the CVP is higher than normal, it may indicate heart failure or that there is high pressure in the lungs that is affecting the right side of the heart.
A doctor will ask about other symptoms, such as chest pain and shortness of breath to help make a diagnosis.
Additional tests may also be carried out to determine the underlying cause of JVD. Listening to the heart can help a doctor pick up signs, such as a heart murmur.
A blood test can also reveal problems with the kidney, liver, or thyroid, which may affect the heart and cardiovascular system, causing JVD.
A doctor may carry out other tests, including an electrocardiogram, which can reveal any problems with the rate or rhythm of the heartbeat, or an echocardiogram, which can help diagnose heart failure and show signs of valve disease or a previous heart attack.
In cases where heart failure is thought to be the underlying cause of JVD, a doctor will work closely with a person to help improve their health. Treatments include:
- changes in lifestyle and diet
- beta-blockers to decrease the activity of the heart and lower blood pressure
- ACE inhibitors, which help to relax the blood vessels
- diuretics, which help to lower blood pressure by flushing salt and fluid out of the body and relaxing blood vessels
In the most severe cases, a heart transplant may be necessary.
The most common underlying cause of JVD is heart failure. A person's outlook depends on how early this is diagnosed, the extent of the damage, their overall health, and how well they respond to treatment.
Early diagnosis is more likely to have a more positive outlook. Anyone experiencing the symptoms of JVD should see a doctor as soon as possible.