The jugular veins () are

vein Veins () are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and feta ...

s that take

blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood is com ...

from the

head A head is the part of an organism which usually includes the ears, brain, forehead, cheeks, chin, eyes, nose, and mouth, each of which aid in various sensory functions such as sight, hearing, smell, and taste. Some very simple ani ...

back to the

heart The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...

via the

superior vena cava The superior vena cava (SVC) is the superior of the two venae cavae, the great venous trunks that return deoxygenated blood from the systemic circulation to the right atrium of the heart. It is a large-diameter (24 mm) short length vei ...

. The

internal jugular vein The internal jugular vein is a paired jugular vein that collects blood from the brain and the superficial parts of the face and neck. This vein runs in the carotid sheath with the common carotid artery and vagus nerve. It begins in the posteri ...

descends next to the

internal carotid artery The internal carotid artery is an artery in the neck which supplies the anterior cerebral artery, anterior and middle cerebral artery, middle cerebral circulation. In human anatomy, the internal and external carotid artery, external carotid ari ...

and continues posteriorly to the

sternocleidomastoid The sternocleidomastoid muscle is one of the largest and most superficial cervical muscles. The primary actions of the muscle are rotation of the head to the opposite side and flexion of the neck. The sternocleidomastoid is innervated by the acces ...

muscle.

Structure and function

There are two sets of jugular veins: external and internal. The left and right external jugular veins drain into the

subclavian veins The subclavian vein is a paired large vein, one on either side of the body, that is responsible for draining blood from the upper extremities, allowing this blood to return to the heart. The left subclavian vein plays a key role in the absorption ...

. The internal jugular veins join with the subclavian veins more medially to form the

brachiocephalic vein The left and right brachiocephalic veins (previously called innominate veins) are major veins in the Thorax, upper chest, formed by the union of the ipsilateral internal jugular vein and subclavian vein (the so-called venous angle) behind the ster ...

s. Finally, the left and right brachiocephalic veins join to form the

, which delivers deoxygenated blood to the right atrium of the heart. The jugular vein has tributaries consisting of petrosal sinus, facial, lingual, pharylingual, the

thyroid The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans, it is a butterfly-shaped gland located in the neck below the Adam's apple. It consists of two connected lobes. The lower two thirds of the lobes are connected by ...

, and sometimes the occipital vein.

Internal

The

is formed by the

anastomosis An anastomosis (, : anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf veins, or streams. Such a connection may be normal (su ...

of blood from the sigmoid sinus of the dura mater and the inferior petrosal sinus. The internal jugular runs with the

common carotid artery In anatomy, the left and right common carotid arteries (carotids) () are artery, arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external carotid artery, external and internal carotid artery, inte ...

and

vagus nerve The vagus nerve, also known as the tenth cranial nerve (CN X), plays a crucial role in the autonomic nervous system, which is responsible for regulating involuntary functions within the human body. This nerve carries both sensory and motor fibe ...

inside the

carotid sheath The carotid sheath is a condensation of the deep cervical fascia enveloping multiple vital neurovascular structures of the neck, including the common and internal carotid arteries, the internal jugular vein, the vagus nerve (CN X), and ansa c ...

. It provides venous drainage for the contents of the

skull The skull, or cranium, is typically a bony enclosure around the brain of a vertebrate. In some fish, and amphibians, the skull is of cartilage. The skull is at the head end of the vertebrate. In the human, the skull comprises two prominent ...

External

The external jugular vein runs superficially to

. There is also another minor jugular vein, the

anterior jugular vein The anterior jugular vein is a vein in the neck. Structure The anterior jugular vein lies lateral to the cricothyroid membrane. It begins near the hyoid bone by the confluence of several superficial veins from the submandibular region. Its tr ...

, draining the submaxillary region.

Clinical significance

Pressure

The

jugular venous pressure The jugular venous pressure (JVP, sometimes referred to as ''jugular venous pulse'') is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different f ...

is an indirectly observed pressure over the

venous system Veins () are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and fetal c ...

. It can be useful in the differentiation of different forms of

and

lung disease The lungs are the primary organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the backbone on either side of the heart. Their function in the respiratory syst ...

. In the jugular veins pressure waveform, upward deflections correspond with (A) atrial contraction, (C) ventricular contraction (and resulting bulging of perspicuous into the

right atrium The atrium (; : atria) is one of the two upper chambers in the heart that receives blood from the circulatory system. The blood in the atria is pumped into the heart ventricles through the atrioventricular mitral and tricuspid heart valves. ...

during isovolumic systole), and (V) atrial venous filling. The downward deflections correspond with (X) the atrium relaxing (and the perspicuous valve moving downward) and (y) the filling of ventricle after the tricuspid opens. Components include: * The a peak is caused by the contraction of the right atrium. * The av minimum is due to relaxation of the right atrium and closure of the

tricuspid valve The tricuspid valve, or right atrioventricular valve, is on the right dorsal side of the mammalian heart, at the superior portion of the right ventricle. The function of the valve is to allow blood to flow from the right atrium to the right vent ...

. * The c peak reflects the pressure rise in the right ventricle early during

systole Systole ( ) is the part of the cardiac cycle during which some chambers of the heart contract after refilling with blood. Its contrasting phase is diastole, the relaxed phase of the cardiac cycle when the chambers of the heart are refilling ...

and the resultant bulging of the tricuspid valve—which has just closed—into the right atrium. * The x minimum occurs as the ventricle contracts and shortens during the ejection phase, later in systole. The shortening heart—with tricuspid valve still closed—pulls on valve opens, the v peak begins to wane. * The y minimum reflects a fall in right atrial pressure during rapid ventricular filling, as blood leaves the right atrium through an open tricuspid valve and enters the right ventricle. The increase in venous pressure after the y minimum occurs as venous return continues in the face of reduced ventricular filling. Elevated JVP

Diseases and conditions

The jugular vein is prominent in

heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to Cardiac cycle, fill with and pump blood. Although symptoms vary based on which side of the heart is affected, HF ...

. When the patient is sitting or in a semirecumbent position, the height of the jugular veins and their pulsations provides an estimate of the central venous pressure and gives important information about whether the heart is keeping up with the demands on it or is failing. Distension of the jugular is a potential sign of heart failure,

cardiac tamponade Cardiac tamponade, also known as pericardial tamponade (), is a compression of the heart due to pericardial effusion (the build-up of pericardial fluid in the pericardium, sac around the heart). Onset may be rapid or gradual. Symptoms typically i ...

, or

coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), or ischemic heart disease (IHD), is a type of cardiovascular disease, heart disease involving Ischemia, the reduction of blood flow to the cardiac muscle due to a build-up ...

. Examination of the neck veins is routinely performed to evaluate atrial pressure and to estimate intravascular volume in patients with dyspnea, edema, or hypovolemia. Elevated venous pressure may indicate left or right ventricular failure or

heart disease Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina pectoris, angina, myocardial infarction, heart attack), heart failure, ...

. Symptoms associated with abnormal flow or pressure in the jugular veins include

hearing loss Hearing loss is a partial or total inability to hear. Hearing loss may be present at birth or acquired at any time afterwards. Hearing loss may occur in one or both ears. In children, hearing problems can affect the ability to acquire spo ...

dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to Balance disorder, disequilibrium or a non-specific feeling, such as giddiness or foolishness. Dizziness is a ...

, blurry vision, swollen eyes, neck pain,

headache A headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of Depression (mood), depression in those with severe ...

s, and sleeping difficulty.

Idiomatic expression

The jugular vein is the subject of an

idiom An idiom is a phrase or expression that largely or exclusively carries a Literal and figurative language, figurative or non-literal meaning (linguistic), meaning, rather than making any literal sense. Categorized as formulaic speech, formulaic ...

in the

English language English is a West Germanic language that developed in early medieval England and has since become a English as a lingua franca, global lingua franca. The namesake of the language is the Angles (tribe), Angles, one of the Germanic peoples th ...

: "to go for the jugular" means to attack decisively at the weakest point. However, this phrase is anatomically inaccurate, as the jugular is not the most critical or vulnerable point in the cardiovascular system. The jugular vein runs parallel to the carotid artery and operates under much lower pressure, returning deoxygenated blood to the heart, whereas the carotid artery, a high-pressure vessel supplying oxygenated blood to the brain, is far more critical and vulnerable in sustaining cerebral circulation.WD, Arora, Y, Mahajan, K
“Anatomy, Blood Vessels.”
StatPearls. Updated 2023 Aug 8. ''StatPearls Publishing,'' 2024. Therefore, to attack at the weakest point, the idiom should be “to go for the carotid”.

References

{{VeinsHeadNeck Veins of the head and neck