Distended jugular veins

Varicose veins are a type of vascular disease. Many people can see very thick purple blood vessels on the calves of their calves. These are varicose veins. However, jugular vein distension and varicose veins are different, although their names look very similar. However, jugular venous distension is caused by right atrial failure, and its obvious manifestation is the distension and swelling of the jugular vein. Here are some tips for treating jugular vein distension:

The jugular vein is the pressure gauge of the right atrium and can reflect changes in right atrial pressure and volume. When the patient takes a semi-recumbent position of 30° to 45°, the external jugular vein fills to a height exceeding the normal level, which is called jugular venous distension. Jugular venous distention accompanied by a positive hepatojugular reflux sign is an important indicator for the clinical diagnosis of right heart failure.

Common causes: right heart failure, pericardial disease, superior vena cava syndrome, respiratory diseases can cause

Common symptoms: The jugular vein is full, full, swollen, and pulsating

Causes

1. Right heart failure: such as chronic cor pulmonale, restrictive cardiomyopathy, congenital heart disease, right ventricular infarction, pulmonary embolism, etc.

2. Pericardial lesions: such as pericardial effusion and constrictive pericarditis.

3. Superior vena cava syndrome.

4. Respiratory system diseases: such as tension pneumothorax, bronchial asthma-status asthmaticus, etc.

Clinical manifestations: The jugular vein is full, plump, swollen and pulsating.

examine

1. Physical examination

Perform a cardiopulmonary and systemic examination. During the examination, the patient takes a semi-recumbent position at 30° to 45°, and the filling of the external jugular vein is observed. The diagnosis is made when the jugular vein is filled to more than 2/3 of the distance from the upper edge of the clavicle to the angle of the mandible.

2. Auxiliary examination

(1) Chest X-ray or film.

(2) Electrocardiogram (ECG)

(3) Echocardiography.

(4) Examinations of white blood cells, blood gas analysis, erythrocyte sedimentation rate, etc.

(5) Chest CT and MRI.

diagnosis

1. Medical history

The patient was asked about the time of appearance of the jugular vein, the precipitating factors, whether there was jugular venous pulsation, and any history of heart disease, trauma, and smoking.

2. Clinical manifestations

The jugular vein is full, plump, swollen, and pulsating.

3. Auxiliary examination

(1) Chest X-ray or film: Pericardial effusion examination shows that the heart shadow is enlarged to both sides, flask-shaped, and the heart beat is weakened or disappeared; constrictive pericarditis shows that the heart shadow is triangular and the pericardium is calcified.

(2) Echocardiography: It plays an important role in the diagnosis of the causes and pathologies of certain heart diseases and is one of the important means of diagnosing the causes of heart disease.

(3) Electrocardiogram: Atrioventricular hypertrophy, conduction block, myocardial ischemia, ectopic rhythm, etc. may be seen.

treat

1. General treatment

Control fluid retention, strictly limit sodium salt intake, and use diuretics with caution.

2. Treatment of the cause

(1) Patients with right heart failure caused by massive pulmonary embolism and pulmonary hypertension should receive early thrombolytic and anticoagulant treatment, and surgical thrombectomy if necessary.

(2) For patients with heart failure, diuretics are used to reduce jugular vein distension and edema.

(3) Patients with pericardial constriction should undergo pericardiotomy as soon as possible.

(4) For patients with cardiac tamponade, pericardiocentesis or fenestration drainage should be performed to relieve compression of the right heart.

(5) For patients with superior vena cava compression syndrome, the primary disease should be actively treated.

3. Surgery

Atrial septostomy, heart transplantation, etc.

4. Others

(1) Reduce right ventricular preload and afterload and enhance myocardial contractility.

(2) Synchronized treatment and rhythm control.

(3) Antiplatelet and anticoagulant treatment.