Читать книгу Respiratory Medicine - Stephen J. Bourke - Страница 60

The jugular veins are examined with the patient in a semi‐reclining position, with the trunk at an angle of about 45° from the horizontal. The head is turned slightly to the opposite side and fully supported so that the sternocleidomastoid muscles are relaxed. The jugular venous pulse is seen as a diffuse superficial pulsation of multiple waveform that is distinct from the carotid arterial pulse. The height of the pulse wave is measured as the vertical height of the top of the oscillating column of blood above the sternal angle. The jugular venous pressure normally falls during inspiration. It is elevated in right heart failure, which may occur as a result of pulmonary embolism or cor pulmonale in COPD, for example. Other signs of right heart failure, such as hepatomegaly and peripheral oedema, may also be present.

Figure 2.2 Clubbing. (a) Normal: the ‘angle’ is shown. (b) Early: the angle is absent. (c) Advanced: the nail shows increased curvature in all directions, the angle is absent, the base of the nail is raised up by spongy tissue and the end of the digit is expanded.