If you ever see someone with a bulging neck vein, you’re looking at the external jugular vein. When the jugular vein is visible, it’s known as jugular vein distention (JVD).

Internal and external jugular veins run along the right and left sides of your neck. They bring blood from your head to the superior vena cava, which is the largest vein in the upper body. The vena cava runs to your heart, where blood arrives before passing through your lungs to pick up oxygen.

JVD is a sign of increased central venous pressure (CVP). That’s a measurement of the pressure inside the vena cava. CVP indicates how much blood is flowing back into your heart and how well your heart can move that blood into your lungs and the rest of your body.

JVD is a symptom of several different cardiovascular problems. Some of them can be life-threatening. Contact your doctor right away if you have JVD.

JVD occurs when the CVP increases above a normal or healthy level. This can be caused by several conditions.

Right-sided heart failure

Heart failure means your heart has grown too weak to effectively pump enough blood to meet the demands of your body.

Right-sided heart failure usually develops after you have left-sided heart failure. The left ventricle pumps blood out through the aorta to most of your body. The right ventricle pumps blood to your lungs. When the left ventricle’s pumping power weakens, fluid can back up into your lungs. This eventually weakens the right ventricle.

When your heart’s right side can’t properly empty, blood can back up into the veins, causing them to bulge.

Pulmonary hypertension

Pulmonary hypertension occurs when the pressure in your lungs increases, sometimes as a result of changes to the lining of the artery walls. This can also lead to right-sided heart failure.

Tricuspid valve stenosis

The valve that separates the right atrium and the right ventricle can become stiff. As a result, it may be unable to open up enough to let all the blood in the atrium flow into the ventricle. Blood can back up in the atrium, causing a backup of blood in the veins, including the jugular veins.

Superior vena cava obstruction

This is a rare condition, usually caused by a tumor in the chest that restricts blood flow in this large vein.

Constrictive pericarditis

The pericardium is a thin, fluid-filled sac that surrounds your heart. An infection of the pericardium, called constrictive pericarditis, can restrict the volume of the heart. As a result, the chambers can’t fill with blood properly, so blood can back up into veins, including the jugular veins.

The most common risk factor for JVD is heart failure. Your risk of heart failure is increased if you have chronic high blood pressure or coronary artery disease (CAD). CAD is narrowed arteries in the heart. It can result in a heart attack, which can weaken the heart muscle. Heart valve disease and irregular heart rhythms, known as arrhythmias, can also lead to heart failure.

To help determine your CVP, your doctor will actually measure the height of the bulge.

While you’re lying down on an exam table, with the head of the table at a 45-degree angle and your head turned to the side, your doctor will measure the highest point at which pulsations can be detected in your internal jugular vein. The internal jugular vein is more reliable than the external jugular vein because the internal blood vessel is in more of a direct line to the right atrium. The right atrium is the chamber of the heart that receives blood from the vena cava.

A normal or healthy CVP is about 6 to 8 centimeters of water (cm H20). A higher CVP suggests heart failure or high pressure in your lungs that backs up into the right side of your heart. Vascular disease means there are problems with one or more blood vessels. Other symptoms, such as chest pain, shortness of breath, and fatigue may help your doctor start to diagnose the cause of your JVD.

Call your local emergency services if you:

  • have chest pain
  • break out in a cold sweat
  • have bluish lips
  • can’t catch your breath
  • experience a rapid heart rate
  • feel faint

Treatment for a JVD means treating the underlying cause of the problem. Diagnosing that problem usually requires a physical exam, including a close listen to the heart. Your doctor will be listening for several signs, including a murmur, which could indicate valve disease. A blood test can help your doctor diagnose diseases of the kidney, liver, or thyroid that might be contributing to your cardiovascular problem.

Certain other screenings or imaging tests are also appropriate. An electrocardiogram can help diagnose an arrhythmia. An echocardiogram can help diagnose heart failure, as well as valve disease or signs of a previous heart attack.

If the diagnosis is heart failure, treatment usually starts with a combination of healthy lifestyle changes and medications. Some common heart failure drugs include beta-blockers, which reduce the workload of the heart and help lower blood pressure. You’ll likely take an ACE inhibitor, and you may need diuretics to control the extra fluid that occurs with heart failure. Other medications may be added depending on how severe the heart failure is.

If you’re diagnosed with heart failure or any potential cause of JVD, work closely with your cardiologist to manage your health and reduce your odds of complications. Circulation problems can result in fatigue and thinking or memory problems. You may also experience liver and kidney problems.

Longer-term treatment of heart failure may include the need for an artificial pump to keep blood flowing at a healthy rate. The most serious cases require a heart transplant.

Because JVD is often a sign of a heart failure, your outlook depends primarily on how well you manage your heart and blood vessel health. The more you can adhere to your medication regimen, exercise, and eat a heart-healthy diet, the better your prognosis. You’ll need to manage your weight and quit smoking. It’ll also be very important to follow through on all your doctor appointments and tests.

JVD may be the first sign you notice of cardiovascular disease, so don’t ignore it. The sooner you are diagnosed and treatment begins, the better your odds of a positive outcome.