The jugular pulse in pericardial constriction: Its differentiation from that of cardiomyopathy

Abstract

Study of the indirect jugular pulse has potential value in differentiation of cardiomyopathies from constrictive pericarditis, often a difficult clinical problem. Twelve patients with constrictive pericarditis were compared with 12 patients with cardiomyopathy and 15 normal subjects. The interval between the aortic second sound and the jugular V wave peak (A 2V) was determined for each case. Nine of 12 patients with cardiomyopathy and all 15 normal subjects had an A 2V greater than 0.03 second, while in 9 of 12 cases with constrictive pericarditis A 2V was less than 0.03 second. Thus, using A 2V alone, the distinction between cardiomyopathy and constrictive pericarditis could be made in 18 of our 24 patients. A 2V reflects the isovolumic relaxation time of the right ventricle. This is shortened in constrictive pericarditis because of a high right atrial pressure and relatively normal right ventricular pressure. Study of the jugular pulse in this manner provides a safe, inexpensive, and noninvasive adjunct in diagnosing constrictive pericarditis.