UMEM Educational Pearls

Category: Cardiology

Title: JVD + hypotension

Keywords: jugular venous distension, hypotension (PubMed Search)

Posted: 3/29/2009 by Amal Mattu, MD (Updated: 12/2/2023)
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Patients with catastrophic cardiovascular conditions often manifest with JVD + hypotension. The DDx for this combination is therefore critical to know:

  1. large LV MI
  2. right ventricular MI
  3. cardiac tamponade
  4. tension PTX
  5. massive PE
  6. acute mitral regurgitation
  7. acute aortic regurgitation

You can make a diagnosis clinically among these 7 entities by:

  1. Listening to the lungs
  2. Listening for murmurs
  3. Getting an ECG.

Of course if you have bedside U/S, it becomes even easier. ECG is almost always diagnostic with either the large LV MI or RV MI. Wet lungs found in large LV MI, acute MR, and acute AR. Murmur found in MR (systolic) and AR (diastolic).