Examination of the Neck Veins

To the Editor: The video by Assavapokee and Thadanipon (Dec. 10 issue) 1 provides a tutorial on how to evaluate the neck veins, an important skill in physical diagnosis that is often not taught well these days. However, I would like to challenge two of their statements. First, normal jugular venous pressure and the absence of the abdominojugular reflux sign rule out heart disease as a cause of edema but not of dyspnea. An elevated left ventricular diastolic pressure or left atrial pressure (which may be caused by a number of cardiac diseases) can produce left heart failure and dyspnea without . . .