jugular vein filling
Introduction
Introduction If the average diastolic pressure gradient exceeds 53 kPa (4 mmHg), the average right atrial pressure can be increased to cause venous congestion, which is characterized by jugular vein filling, hepatomegaly, ascites, and edema. Various organic diseases that cause right heart failure: chronic pulmonary heart disease, pulmonary embolism, congenital heart disease including primary pulmonary hypertension, pulmonary stenosis E-bstein malformation, Eisenmenger syndrome, rheumatic Heart disease includes tricuspid stenosis and/or tricuspid regurgitation, restrictive cardiomyopathy.
Cause
Cause
The average diastolic pressure gradient exceeds 53 kPa (4 mmHg):
1. Various organic diseases that cause right heart failure: chronic pulmonary heart disease, pulmonary embolism, congenital heart disease including primary pulmonary hypertension, pulmonary stenosis E-bstein malformation, Eisenmenger syndrome, Rheumatic heart disease includes tricuspid stenosis and/or tricuspid regurgitation, restrictive cardiomyopathy.
2, mainly for the performance of increased systemic venous pressure. In the semi-recumbent position or sitting position, a filling of the external jugular vein can be seen above the clavicle, and the dry neck reflux sign is positive. When the swollen liver is compressed, the jugular vein filling is intensified, which is an early manifestation of right heart dysfunction. Or other superficial veins can also be seen filling and anger.
Examine
an examination
Related inspection
Jugular venous return test jugular venous pressure examination liver-jugular venous return jugular vein test abdominal jugular vein reflow test
1. Right heart failure: Pulmonary heart disease, congenital heart disease and rheumatic heart disease can cause right ventricular preload and cause right heart failure, causing systemic congestion.
2, limited heart filling: normal pressure in the pericardial cavity is lower than atmospheric pressure, but also lower than atrial pressure and ventricular diastolic pressure. When the pericardial effusion rapidly accumulates and (or) the amount of exudate exceeds a certain level, the pressure inside the pericardium Sudden rise, or the pericardium thickens and stiffens. Fibrosis causes the pericardium to narrow, and the entire heart and large blood vessel outlets are oppressed, preventing ventricular diastolic and filling from affecting blood flow back to the right heart, causing the venous pressure to rise.
3, the superior vena cava obstruction, the upper vena cava backflow is blocked, causing jugular vein engorgement.
Diagnosis
Differential diagnosis
According to the typical murmur, right atrial enlargement and symptoms and signs of systemic congestion, diagnosis can be made generally. For patients with difficult diagnosis, right heart catheterization can be performed. If the tricuspid valve has an average transvalvular pressure difference of 0.27 kPa (2 mmHg) or more. That is, the diagnosis of right atrial myxoma can be diagnosed as tricuspid stenosis.
The identification of this disease and other important diseases are as follows:
1, right atrial myxoma, when the tumor obstructs the valve hole, it can also cause the clinical manifestations of tricuspid stenosis, but the history is short, the disease progresses rapidly, and the echocardiogram has a unique cloud-like image, which can be identified.
2, the main symptoms of tricuspid stenosis caused by gastrointestinal tract and liver and spleen stagnation, such as liver discomfort, loss of appetite, indigestion and bloating. Sometimes accompanied by fatigue and swelling of the limbs. Simple tricuspid stenosis, cardiopulmonary disease is not obvious, patients with mitral stenosis, but also due to decreased right ventricular blood flow, cardiopulmonary symptoms are milder than simple mitral stenosis.
3, physical examination can be seen on the cheeks mild hair and jaundice (caused by chronic liver stagnation), jugular vein engorgement, and even pulsation. Hepatomegaly, hard and tender, sometimes pulsating before systole. Those with ascites have a swollen abdomen and have a mobile dullness. At the time of the heart examination, the heart sounds are widened to the right. The first sound of the tricuspid region is hyperthyroidized, and after the second sound, there is an open beat. The fourth intercostal space on the left sternal border can be heard before or during diastolic squeaky murmurs, sometimes touching tremors. When inhaling deeply, the blood flow in the right atrium increases due to the increase of the negative pressure in the chest, and the noise is obviously enhanced, which can be distinguished from the mitral stenosis. Hepatomegaly, ascites and edema.
