The Oscillating Component of the Internal Jugular Vein Flow: The Overlooked Element of Cerebral Circulation.

Francesco Sisini,Eleuterio Toro,Paolo Zamboni,Mauro Gambaccini

doi:10.1155/2015/170756

Francesco Sisini, Eleuterio Toro + Show 2 more

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https://doi.org/10.1155/2015/170756

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Abstract

The jugular venous pulse (JVP) provides valuable information about cardiac haemodynamics and filling pressures and is an indirect estimate of the central venous pressure (CVP). Recently it has been proven that JVP can be obtained by measuring the cross-sectional area (CSA) of the IJV on each sonogram of an ultrasound B-mode sonogram sequence. It has also been proven that during its pulsation the IJV is distended and hence that the pressure gradient drives the IJV haemodynamics. If this is true, then it will imply the following: (i) the blood velocity in the IJV is a periodic function of the time with period equal to the cardiac period and (ii) the instantaneous blood velocity is given by a time function that can be derived from a flow-dynamics theory that uses the instantaneous pressure gradient as a parameter. The aim of the present study is to confirm the hypothesis that JVP regulates the IJV blood flow and that pressure waves are transmitted from the heart toward the brain through the IJV wall.

Highlights

The evaluation of the jugular venous pulse (JVP), defined as the movement of expansion of the jugular vein due to changes in pressure in the right atrium, provides valuable information about cardiac haemodynamics and filling pressures [1], characteristic wave patterns pathognomic of cardiac diseases [2], and an indirect estimate of the central venous pressure (CVP)
It has been proven that JVP can be obtained by measuring the crosssectional area (CSA) of the IJV on each sonogram of an ultrasound B-mode sonogram sequence
It has been proven that during its pulsation the IJV is distended and that the pressure gradient drives the IJV haemodynamics. It will imply the following: (i) the blood velocity in the IJV is a periodic function of the time with period equal to the cardiac period and (ii) the instantaneous blood velocity is given by a time function that can be derived from a flow-dynamics theory that uses the instantaneous pressure gradient as a parameter

Summary

Introduction

The evaluation of the jugular venous pulse (JVP), defined as the movement of expansion of the jugular vein due to changes in pressure in the right atrium, provides valuable information about cardiac haemodynamics and filling pressures [1], characteristic wave patterns pathognomic of cardiac diseases [2], and an indirect estimate of the central venous pressure (CVP). A direct explanation of this finding is that, when in supine position, the pulsation of the IJV is a distension of its wall This result is very important because it means that there is a time varying transmural pressure whose effect is clearly visible and cannot be neglected; large changes in transmural pressure are required to induce CSA deformation accompanied by a stretching of the wall [5, 6]. If this is true the following points are true: (i) the blood velocity in the IJV is a periodic function of the time with period T equal to the cardiac period and (ii) the instantaneous blood velocity

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