Background: Exacerbation of congestive heart failure (eCHF) is a common cause of dypnea in patients presenting to the emergency department (ED). eCHF is often challenging to diagnose in the ED setting and a bedside adjunct would be a useful diagnostic tool. Historically, eCHF has been purported to cause jugular venous distension on physical exam.
Objectives: We sought to determine if bedside ultrasound could detect a difference in the size and collapsibility of the internal jugular vein (IJV) of patients with eCHF versus healthy controls.
Methods: In this case-control trial using bedside ultrasound, we examined the IJVs of 26 healthy volunteers and 20 ED patients with confirmed eCHF. We imaged the veins with individuals lying flat as well as at a bed incline of 45 and 60 degrees. IJV area ratios (IJARs) were calculated by dividing the IJ area measured at 60 degrees by the IJ area at 0 degrees.
Results: Median IJARs were 0.138 cm2 (IQR = 0–0.262) in control subjects, and 0.701 cm2 (IQR = 0.215–0.889) in eCHF patients. A two-tailed Wilcoxon test howed significant differences in IJARs between the groups (p = 0.00015). Odds of complete IJV collapse were determined by logistic regression. Controls were found to have significantly greater odds of complete IJV collapse than patients with eCHF (OR 11.73, 95%CI 1.346–102.3, p = 0.026). Patients with eCHF were significantly older, more overweight asmeasured by BMI, and had higher measured mean and systolic blood pressure.
Conclusion: While there are several limitations to this study, a significant difference in collapsibility of the IJV was demonstrated between control subjects and patients with eCHF.
Graph 1. Proportion of IJ collapse at bed incline of 60 degrees.
Patients with acutely decompensated heart failure had less IJ collapse compared to the healthy control group.