Jugular Vein Distention (JVD): Causes and Treatments

Jugular vein distention (JVD) is a bulging of large veins that run down the side of your neck. JVD can cause a vein to “stick out,” because blood is backing up in the heart or the vein that carries oxygen-depleted blood from the body back to it.

JVD is always a concerning sign of a cardiovascular problem, including heart failure, even when it’s not painful. Immediate medical care is necessary.

This article will go over what causes jugular vein distention. You’ll also learn about the symptoms that can go along with JVD, as well as the signs that you need emergency medical treatment.

Causes of JVD

JVD is associated with a number of significant health conditions affecting the heart and lungs. Its presence, along with symptoms that may be specific to a certain diagnosis, can help a healthcare provider identify and treat the problem.

Right-Sided Heart Failure

With right-sided heart failure, the right side of the heart isn’t pumping blood as well as it should. It usually happens after left-sided heart failure, which causes increased pressure on the right side to pump blood. Over time, the right side is weakened and cannot work as well.

Blood then accumulates in the veins and leads to a bulging jugular vein. Symptoms can include shortness of breath, edema (swelling), and fatigue along with JVD.

Pulmonary Hypertension

Pulmonary hypertension is when the pressure of blood in the vessels between the heart and lungs is too high. The pulmonary artery is the blood vessel that carries blood from the heart’s right ventricle to the lungs. When pressure increases there, pulmonary hypertension occurs.

Symptoms range from mild to severe. In mild cases, a person may not experience any symptoms, but in more severe cases, pain and loss of consciousness can occur. Other symptoms may include shortness of breath, fatigue, chest pain, and edema.

Pulmonary hypertension can cause JVD due to the increased pressure in the vein, causing it to bulge.

Constrictive Pericarditis

Constrictive pericarditis is a chronic condition in which the pericardium, the membrane around the heart, becomes stiff and inelastic. Due to the loss of elasticity in the pericardium, also called the pericardial sac, cardiac function is negatively impacted, leading to symptoms that gradually worsen.

People with this condition often have a thickened or calcified pericardium, as well as dilation (expansion) of major veins due to the backing up of blood. One of these veins is the jugular vein.

This can result in JVD, which leads to increased venous pressure. Constrictive pericarditis is relatively rare but it’s usually chronic and can be life-threatening if left untreated.

Superior Vena Cava Obstruction

The superior vena cava is one of the main veins in the body. It transports blood from your arms, chest, neck, and head to your heart. The jugular vein is one of several veins of the neck that connect to the superior vena cava. When there is an obstruction in the superior vena cava, it becomes compressed or blocked.

Depending on the severity of the condition, symptoms may be nonexistent or mild. The blockage can progress, causing extreme symptoms, including chest pain, coughing up blood, and wheezing.

This obstruction can cause distention in other veins, including:

• The axillary veins (paired veins of the upper limb)
• Subclavian veins (paired veins responsible for draining blood from the upper extremities)

Superior vena cava obstruction is rare, but it’s serious and often caused by dire conditions like cancer or an infection.

Cardiac Tamponade

Cardiac tamponade is a medical emergency. In this condition, blood and fluid accumulate in the pericardial sac and compress the heart. When this happens, cardiac output is stunted and can also lead to shock, a sudden drop in blood flow throughout the body.

The buildup of fluid that causes cardiac tamponade can be a result of hemorrhage (bleeding) from a penetrating wound to the heart or ventricular wall rupture after a heart attack.

Symptoms usually include chest pain, palpitations, shortness of breath, and altered mental status. A person with cardiac tamponade can also present with JVD due to the backup of blood in the veins.

Tension Pneumothorax

A pneumothorax is a collapsed lung, which can happen when air collects between your lungs and chest wall, called the pleural space, and cannot escape. A pneumothorax can be a complete or partial lung collapse.

There are several types of pneumothorax, including open and tension. An open pneumothorax occurs when air accumulates between the chest wall and the lungs as a result of an open chest wound or other physical defect. 

Tension pneumothoraces occur when air accumulates between the chest wall and the lung and increases pressure in the chest, reducing the amount of blood returned to the heart. It can cause jugular vein distention.

Tricuspid Valve Stenosis

The tricuspid valve is between the right atrium and the right ventricle of the heart. Tricuspid valve stenosis is one of four types of tricuspid valve diseases. In tricuspid valve stenosis, there is a narrowing of the valve opening, restricting blood flow between the upper and lower parts of the right side of the heart.

This condition leads to an enlarged right atrium, resulting in increased pressure and blood flow in the surrounding veins. Tricuspid valve stenosis often causes increased jugular venous pressure and bulging of the vein.

Tricuspid valve stenosis is uncommon and usually occurs along with another valvular issue. If the condition is mild or moderate, treatment may not be needed. However, you should still see your healthcare provider. In severe cases, surgery may be required.

Symptoms of JVD

The main symptom of JVD is the obvious bulge in neck veins that indicates a problem with blood flow back to the heart. Other common symptoms may include:

• Shortness of breath, including fluid on the lungs
• Edema (swelling) in the feet, legs, and hands
• Chest pain
• Heart arrythmias (irregular heartbeats)
• Confusion and altered mental status
• Coughing up blood
• Fatigue 

Some conditions will have specific symptoms. For example, with a tension pneumothorax you will have difficulty getting enough oxygen because of the collapsed lung. Cyanosis, which causes a blue or ashen tinge to the skin, might occur with the JVD.

Risk Factors

In many cases, the risk factors for JVD are related to a specific underlying cause of the jugular vein back-up that causes the swelling. That’s the case with heart failure and related heart and lung conditions, but the risk of JVD can extend to other health issues, too.

For example, people living with lupus or scleroderma may be more likely to experience acute pericarditis that leads to the more chronic form, constrictive pericarditis. Infection also may contribute to a higher risk of developing JVD.

Some risk factors are linked to lifestyle choices that can be modified to reduce the risk of heart failure and other causes of JVD. They include:

Fluid levels in your body can contribute to JVD, so be sure to discuss medication and other ways to manage or restrict fluids with your healthcare provider.

Diagnosis of JVD

JVD is diagnosed on the basis of the distention in the neck. Your healthcare provider will perform a physical exam, watching for pulsations in the neck veins and checking to see how they might change in different positions or if your breathing alters the pattern.

If JVD is present, then it is assigned a measure in terms of centimeters of venous pressure. This value is considered within the context of your overall health history and conditions that may lead to JVD, along with your other symptoms and test findings.

These tests may include:

• Imaging, such as a chest X-ray or computerized tomography (CT)
• Arterial blood gas testing, which measures blood oxygen and carbon dioxide levels
• Specific cardiac function tests, like echocardiography (cardiac echo ultrasound)

Keep in mind that a diagnosis of JVD points to another underlying cause. Some tests, such as a heart catheterization, may be needed to diagnose specific conditions like pulmonary hypertension.

Treatment for JVD

Since JVD is a symptom of an underlying disease, treatment is focused on the cause of the blockage or backup into the jugular vein. These treatments will vary depending on the diagnosis.

Healthcare providers typically try the least invasive methods first. If your condition is not critical, they may recommend lifestyle changes and medications meant to reduce your body fluid levels or improve your heart function. These medications may include:

• Beta blockers
• Diuretics
• Angiotensin-converting enzyme (ACE) inhibitors

Your healthcare team can explain your diagnosis and treatment options with you, including the need for surgery and other interventions.

Summary

Jugular vein distention (JVD) occurs when neck veins bulge out because of pressure. This happens because blood is not returning to the heart properly, and it may occur along with symptoms including chest pain and shortness of breath.

JVD often signals the presence of a serious underlying issue, usually involving the heart and lungs. These conditions include right-sided heart failure, pericarditis, and other cardiac health concerns.

These causes can usually be managed if you see a healthcare provider right away for diagnosis and treatment. But it’s critical that you do so if you experience JVD, because the symptom is associated with conditions (like cardiac tamponade) that can prove fatal if not treated immediately.