I want to know how jugular vein distention plays a role in chf and how
important it is when you see it to have it treated? also what heart
evaluation tests must be done for someone with suspected chf?

Hi - quick disclaimer, the information provided herein is meant solely
for informational purposes and does not substitute for the opinion of
a licenced healthcare professional.

Congestive heart failure is a condition in which the heart can no
longer pump blood efficiently throughout the body.  Due to the
inability of the heart to adequately pump blood, blood backs-up into
the venous system (the veins of the body where blood is returning from
the body to the heart).  The blood which backs-up causes "congestion"
in these organs.  This congestion is manifest by peripheral edema
(limb swelling, usually in the legs), pulmonary edema (fluid in the
lungs, causes coughing, difficulty breathing, shortness of breath),
congestive hepatomegaly (liver damage due to backed-up blood in the
liver), and jugular venous distention (swelling of the neck veins due
to excess blood).

In a recent study last year published in the New England Journal of
Medecine (a well respected medical journal), it was reported that
jugular venous distention is an independent risk factor for poor
outcomes in patients with CHF - basically this means that having JVD
indicates a poor state of the patient's heart regardless of which
other symptoms are found.  An explanation of this article can be
found:
http://www.newswise.com/articles/2001/8/EXAM.SWM.html
http://dallas.bizjournals.com/dallas/stories/2001/08/20/daily29.html

the abstract of the article:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11529211&dopt=Abstract

and the article itself (although it is not free):
http://content.nejm.org/cgi/content/full/345/8/574

Tests which should be done for a patient with CHF:

Blood tests - tests can be done on cardiac enzymes (can help
demonstrate if a recent heart attack is causing or worsening the
symptoms of CHF) and liver enzymes (to examine for liver damage due to
congestive failure).  An arterial blood gas (ABG) can be drawn to
examine how well the lungs are putting oxygen into the blood (as heart
failure worsens, the lungs become full of fluid and cannot put oxygen
into the blood very well).

Chest X-ray - as the heart fails it gets bigger (or distends) - these
changes can be seen by looking at the heart on an x-ray.  An x-ray can
also examine for pulmonary edema (fluid in the lungs).

Echocardiography (an "echo" or "cardiac echo") - this is an ultrasound
examination of the heart which can measure its size and ability to
pump blood (the size goes up and the ability to pump decreases with
heart failure).

Electrocardiogram (EKG or ECG) - this is a test of the electrical
system of the heart which allows it to beat - as the heart fails and
enlarges, the electrical system is altered which can be detected by
changes in the measurement of the heart's electrical activity (the
EKG).


A good, approachable page on heart failure from CHFpatients.com,
titled "The Manual" - this site also contains many other useful links
to information on CHF
http://www.chfpatients.com/CHFinfo.htm

A good page from WebMD.com on the physical exam which a doctor will
perform and what it can indicate (mentions JVD as "swelling of the
neck veins"):
http://my.webmd.com/encyclopedia/article/1675.62013

Another nice page from WebMD.com on heart failure (does not
specifically mention JVD):
http://my.webmd.com/encyclopedia/article/1675.60669

Two good pages on heart failure, mainly intended for doctors from
eMedicine.com:
http://www.emedicine.com/EMERG/topic108.htm
http://www.emedicine.com/wild/topic17.htm

Another nice page meant for doctors:
http://www.vh.org/Providers/ClinRef/FPHandbook/Chapter03/04-3.html


synarchy

JVD is simply a sign; like excess smoke from a tailpipe. It can result
from congestive heart failure, as the answer above indicated. It's not
that the JVD, per se, needs treatment; it's that whatever causes it
may need treatment. Also, it is a matter of degree and context: not
all JVD is pathologic; it is normal to see pulsatile fullness in the
jugular vein in various circumstances. Likewise, not all JVD which is
pathologic is due to CHF: it can, for example, also be seen in certain
heart valve abnormaliites.

This a response more to surgeon-ga than to the original question:

The NEJM article does suggest that JVD in CHF is associated with a
worse prognosis.  The fact that this comes up as an independent risk
factor I think suggests that this is an important sign to monitor in
patients with CHF - while it may be simply a sign of other conditions
(as you mention), it's importance in the prognosis of CHF appears to
be somewhat demonstrated.  As the question revolved around the
importance of JVD in CHF, that is how I approached the question.