Elevated Jugular Venous Pressure with Y-Dip on Inspection.
An 80-year-old man was transferred to our hospital (day 1) from a local hospital because of
persistent dyspnea on exertion for two weeks. He had aortic valve replacement with a mechanical valve for aortic valve stenosis 8 years prior to this admission and 40 pack-years of smoking, though he had stopped smoking 8 years prior to this admission. He had been taking warfarin (3 mg per day), and denied a history of hemoptysis.
On examination, he was in mild respiratory distress. The blood pressure was 112/78 mm Hg, the pulse 98 beats per minute, the temperature 37.3 ºC, respiratory rate 24 breaths per minute, and mild hypoxemia with oxygen saturation of 90% while he was breathing ambient air. Auscultation of the chest revealed coarse crackles at bilateral lower lung fields, predominantly heard on right side. Echocardiography later revealed elevated right ventricular systolic pressure (38 mm Hg) along with right diastolic dysfunction. Careful examination of jugular vein and the assessment of jugular venous wave form have become the “lost art of medicine”, however, as seen in our case, it unmasked the presence of right ventricular dysfunction at the bedside, and facilitated further diagnostic and therapeutic interventions.
He had aortic valve replacement with a mechanical valve for aortic valve stenosis 8 years prior to this admission and 40 pack-years of smoking, though he had stopped smoking 8 years prior to this admission. He had been taking warfarin (3 mg per day), and denied a history of hemoptysis. On examination, he was in mild respiratory distress.
Pulm Res Respir Med Open J. 2016; SE(1): S1-S2. doi:10.17140/PRRMOJ-SE-1-101
