Abstract: Objective: Exacerbation of congestive heart failure (eCHF) is a common cause of shortness of breath in patients presenting to the emergency department (ED). eCHF is often challenging to diagnose in the ED setting and a bedside adjunct would be useful. Historically, eCHF has been purported to cause distended neck veins on physical exam. We sought to determine if bedside ultrasound could detect a difference in the size and collapsibility of the internal jugular vein (IJV) of patients with eCHF versus healthy controls.
Methods: Using bedside ultrasound, we examined the IJVs of 26 healthy volunteers and 20 ED patients with confirmed eCHF. We imaged the veins with individuals lying flat as well as at a bed incline of 45 and 60 degrees.
Results: IJV area ratios (IJARs) were calculated by dividing the IJ area measured at 60° by the IJ area at 0°. Median IJARs were 0.138 cm2 (IQR = 0-0.262) in control subjects, and 0.701 cm2 (IQR= 0.215-0.889) in eCHF patients. A two-tailed Wilcoxon test showed significant differences in IJARs between the groups (p=0.00015). Odds of complete IJV collapse were determined by logistic regression. Controls were found to have significantly greater odds of IJV collapse than patients with eCHF (OR 11.73, 95%CI 1.346-102.3, p=0.026). Patients with eCHF were significantly older, heavier as measured by BMI and had higher measured mean and systolic blood pressure.
Conclusion: While there are several limitations to this study, we demonstrate a significant difference in collapsibility of the IJV between control subjects and patients with eCHF.