Prognostic importance of elevated jugular venous pressure and a third heart sound in patients with heart failure

Related Experiment Video

Updated: Jul 10, 2026

Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
07:10

Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy

Published on: June 18, 2020

M H Drazner1, J E Rame, L W Stevenson

  • 1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75390-9034, USA. mark.drazner@utsouthwestern.edu

The New England Journal of Medicine
|September 1, 2001
PubMed

Insights

Elevated jugular venous pressure and third heart sound in heart failure patients independently predict worse outcomes. These physical exam findings are crucial for assessing heart failure progression and prognosis.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Clinical Research

Background:

  • The prognostic significance of elevated jugular venous pressure (JVP) and third heart sound (S3) in heart failure (HF) patients remains incompletely understood.
  • These physical examination findings are commonly observed in HF but their independent predictive value for adverse outcomes requires further elucidation.

Purpose of the Study:

  • To investigate the independent prognostic value of elevated JVP and S3 in patients with symptomatic heart failure.
  • To determine the association of these physical findings with key adverse outcomes, including hospitalization for HF and HF progression.

Main Methods:

  • Retrospective analysis of 2569 patients from the Studies of Left Ventricular Dysfunction (SOLVD) treatment trial.
  • Patients were randomized to enalapril or placebo, with a mean follow-up of 32 months.
  • Elevated JVP and S3 presence were assessed via physical examination; risks of HF hospitalization and progression were compared.

Main Results:

  • In multivariate analyses of 2479 patients, elevated JVP was significantly associated with increased risk of HF hospitalization (RR, 1.32), death or HF hospitalization (RR, 1.30), and death from pump failure (RR, 1.37).
  • The presence of a third heart sound showed similarly increased risks for these adverse outcomes.
  • These associations remained significant after adjusting for other markers of HF severity.

Conclusions:

  • Elevated jugular venous pressure and a third heart sound are independent predictors of adverse outcomes in heart failure patients.
  • These physical examination findings are associated with an increased risk of heart failure progression.
  • Clinical assessment of JVP and S3 is feasible and provides clinically meaningful prognostic information for heart failure management.
Abstract

More Related Videos

Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography09:31

Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography

Published on: January 27, 2023

Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge09:32

Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge

Published on: January 20, 2023

Related Concept Videos

Assessment of the Cardiovascular System III: Palpation01:27

Assessment of the Cardiovascular System III: Palpation

Palpation involves feeling the body to evaluate texture, size, consistency, and tenderness for assessing cardiovascular health. The following steps are organized in a head-to-toe order:
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the...
Mitral Regurgitation I: Introduction01:20

Mitral Regurgitation I: Introduction

Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
Heart Failure III: Clinical Manifestations01:26

Heart Failure III: Clinical Manifestations

Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
Heart Failure IV: Classification and Diagnostic Evaluation01:30

Heart Failure IV: Classification and Diagnostic Evaluation

Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...