JVP

Q: 54 year old male is admitted to ICU with shortness of breath (SOB). On exam, the lower part of the right ear lobe is found to be pulsating. What is the probable cause of SOB?


Answer: Exacerbation of CHF

Examination of Jugular Venous Pressure (JVP) is essential in exacerbation of congestive heart failure (CHF). The objective of the above question is to highlight the fact that frequently very high JVP can be missed as the pulsation may be hidden high up in the neck! In such patients, it is not unusual to have a pulsatile lower part of the ear lobe. JVP is a reliable prognostic sign and its presence or absence has been found to be correlated with a subsequent increased risk of death.

#cardiology
#physical-exam


References:

1. Ambrosy AP, Pang PS, Khan S, et al. Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial. Eur Heart J 2013; 34:835.


2. Sinisalo J, Rapola J, Rossinen J, Kupari M. Simplifying the estimation of jugular venous pressure. Am J Cardiol 2007; 100:1779.