Does This Patient Have Abnormal Central Venous Pressure?

A 65-YEAR-OLD woman has had dyspnea for 2 months. She has had to give up her hobby of hiking and is now short of breath climbing even one flight of stairs. Her dyspnea is sometimes worse at night. She has no chest pain, cough, or sputum, and the review of systems is otherwise negative. On physical examination, her blood pressure is 135/90 mm Hg, and she has a regular cardiac rhythm at a rate of 72 beats per minute. You turn your attention to the jugular veins and next ask yourself, "Does this patient have abnormal central venous pressure?" WHY IS THIS QUESTION IMPORTANT? Evaluation of the jugular venous pulse provides important information about pressure and other hemodynamic events in the right atrium.¹⁻³Via the former, it provides a useful estimate of central venous pressure (CVP) and thus the patient's intravascular volume status. Inspection of the waveforms can assist