Unhappy Neighbors: JVP and the Thyroid

Myxedematous ascites is a diagnosis just ripe with learning points. Today, we discussed that cirrhosis does not present with JVP elevation in the absence of complications or comorbid conditions. Myxedema can lead to JVP elevation due to cariogenic shock or pericardial effusion causing cardiac tamponade. Cardiac tamponade typically manifests with Beck's Triad of 1) hypotension, 2) diminished heart sounds, and 3) JVP elevation, but the astute examiner will also assess the character of the jugular venous pulse to assess for absent Y descent (i.e. sluggish early ventricular filling), characteristic of cardiac tamponade (see figure below). 

Additionally, hypothyroidism presenting in the patient with risk factors for pericarditis can present with elevated JVP due to constrictive pericardial disease due to recurrent pericarditis. This was not the cause of JVP elevation in our case but is a known entity that can manifest as both elevated JVP and JVP character abnormalities. This time, rather than y descent blunting, there is y descent exaggeration (see figure).

For more on the intricacies of JVP assessment, see the classic video above by Paul Wood, an oldie, but a goodie.