Abnormal Finding

Neck vein distension at 45 o inclination is abnormal and is indicative of increased central venous pressure. Describe the level to where the pulsations are seen in relationship to the angle of Louis. Note the effect of inspiration. Apply gentle pressure to right upper quadrant and note its effect on neck veins (hepatojugular reflux). If neck vein distension is present identify a, c and v waves and describe their amplitude.