Simplified evaluation of the jugular venous pressure: significance of inspiratory collapse of jugular veins.

The evaluation of the jugular venous pulse (JVP) remains one of the most important elements of the physical examination. Unfortunately, the examination remains difficult for most clinicians since traditional methodology is not commonly used or understood. Echocardiography has shown that the right atrial pressure can accurately be predicted as normal by observing a 50% inspiratory collapse of the inferior vena cava. We have adapted this finding to the clinical examination and experience has shown that if the jugular vein collapses during deep inspiration that both the right atrial pressure and the JVP are normal. We propose that this finding, which is easily detected in most patients, be incorporated as a standard observation in the assessment of the JVP. Thus, when evaluated in the supine position, distended neck veins that do not collapse indicate an abnormally elevated venous pressure, while visible veins that collapse during deep inspiration or with a vigorous sniff suggest a normal JVP, and those that are not (or barely) visible that collapse indicate a low JVP. This methodology is applicable to most clinical situations.

Cardiac physical diagnosis in the digital age: an important but increasingly neglected skill (from stethoscopes to microchips).

With the advent of readily available imaging modalities, the time-honored skills in physical examination of the cardiac patient have eroded and are no longer the hallmark of the expert cardiologist. Although auscultation continues to be the primary focus in the examination, this is a skill in which competency is only achieved through continuous exposure, and does not quantitate the physiologic status of the patient. Accuracy in the examination is best achieved by evaluating the physiologic variables that characterize cardiac function (pulse amplitude, blood pressure, jugular venous pressure, and makers of neurohumoral activation), and the identification of which cardiac chambers are involved using precordial motion and the electrocardiogram. Practical methods for the acquisition of these clinical observations are discussed. These clinical data are often more quantitative and easier to acquire for many clinicians than is proficiency in auscultation, and facilitate accurate diagnosis of cardiac conditions including murmur interpretation. In conclusion, even in the digital age, the physical examination remains uniquely relevant to patient care, particularly when focused on the physiologic status of the cardiac patent.

Nonsurgical Repair of Femoral Artery Pseudoaneurysm with Color Flow Guided Ultrasound Transducer Compression.

Arterial pseudoaneurysm is a significant complication following invasive angiographic procedures. A definitive diagnosis is usually obtainable with ultrasound imaging, including color flow Doppler. Treatment modalities include surgical repair or transducer directed compression. In our experience, 26 of 29 patients (89.7%) with femoral artery pseudoaneurysm were successfully treated utilizing transducer directed compression. One pseudoaneurysm thrombosed spontaneously before the procedure was completed. No complications were encountered. Our experience suggests that surgical repair is not required for most femoral artery pseudoaneurysms. (ECHOCARDIOGRAPHY, Volume 13, May 1996)