JVP and RAP

Q: What is the 'rule of thumb formula to assess Right Atrial Pressure (RAP) from Jugular Venous Pressure (JVP)?

Answer: RAP (in cm of water*) = JVP + 5cm

* 1 cm water = 0.74 mmHg

Although this formula is a rough estimate but provides a general idea of RAP to determine further workup and establish a differential diagnosis.

5 cm is added due to the understanding that the right atrium is located about 5 cm below the sternal angle. It has been suggested that 5 cm should be used only when the patient is supine. The number should be increased to 8 cm or 10 cm depending on head elevation. Overall body habitus also influences this number. Said that again, 5 cm provides a clinician a pretty general idea of cardiac pathology.

#physical exam

#cardiology

References:

1. Stein JH, Neumann A, Marcus RH. Comparison of estimates of right atrial pressure by physical examination and echocardiography in patients with congestive heart failure and reasons for discrepancies. Am J Cardiol 1997; 80:1615.

2. Devine PJ, Sullenberger LE, Bellin DA, Atwood JE. Jugular venous pulse: window into the right heart. South Med J 2007; 100:1022.

3. Seth R, Magner P, Matzinger F, van Walraven C. How far is the sternal angle from the mid-right atrium? J Gen Intern Med 2002; 17:852.

4. McGee SR. Physical examination of venous pressure: a critical review. Am Heart J 1998; 136:10.