An emergency room patient is lying on his bed with his head elevated at a 45-degree angle. An RT, who is coming to examine the patient, notices that the patient's jugular vein extends ap-proximately 7 cm above his sternal angle
What can the RT assume about this patient's condition?
a. Cor pulmonale
b. Pneumonia
c. Kussmaul's sign
d. Pneumothorax
ANS: A
When lying in a supine position, a healthy individual has neck veins that are full. When the head of the bed is elevated gradually to a 45-degree angle, the level of the blood column descends to a point no more than a few centimeters above the clavicle. With elevated venous pressure, the neck veins may be distended as high as the angle of the jaw, even when the patient is sitting upright. Jugular venous distention (JVD) is present when the jugular vein is enlarged and it can be seen more than 3 to 4 cm above the sternal angle. The most common cause of JVD is heart failure (cor pulmonale). Heart failure frequently occurs with advanced COPD because of hypoxemia. This causes chronic pulmonary vasoconstriction and hypertension which leads to right heart failure from the excessive workload. Other conditions associated with JVD include left heart failure, cardiac tamponade, tension pneumothoraces, and mediastinal tumors.
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