Does the absence of external jugular venous distension rule out central venous congestion?
No. Venous constriction may occur in the external jugulars and so mask distension. What is the level of the internal jugular pulsations when measured on a normal individual lying inclined at a 45º angle? In normal individuals, the jugular pulse should lie less than 4.5 cm above the angle of Louis. Elevation is measured using two rulers. One extends horizontally from the level of the jugular pulsations out over the sternum, while the other extends vertically from the angle of Louis. The vertical distance between the angle of Louis and the horizontal ruler is the jugular venous pressure (JVP). How do you distinguish internal jugular pulsation from the carotid pulsation? • Carotid pulsation is palpable and jugular pulsation is not. • Gentle pressure over the lower neck will eliminate the jugular pulsation, but not the carotid pulsation. • Jugular pulsation is usually a double wave (a wave and v wave), while carotid pulsation is a single wave. (In fact, what you see best is the double desc
