Next, we shall evaluate the jugular venous pulse. It lies just inferolateral to the sternocleidomastoid muscle. And when we evaluate it, we assess two things, the central venous pressure and the wave form. We shall now evaluate the central venous pressure. I can see the impulse right down here, and it’s a couple of centimeters lower than the sternal angle. Now, since the sternal angle is approximately 5 cm higher than the mid right atrium, and since this is slightly lower than the sternal angle, I’d assess our patient’s central venous pressure at 3, that is, normal.

But be careful, because once in a while you get a great clue from looking at that central venous pressure. It may occasionally be elevated in those cases, especially with inferior infarctions, where there is also right ventricular infarction. And then the central venous pressure could be elevated. In other cases, the central venous pressure may be low. You may have difficulty even seeing the veins, and then you think hypovolemia.