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Doctor Nash
Doctor Nash, Professor of Medicine (MD)
Category: Health
Satisfied Customers: 616
Experience:  I've been teaching and practicing medicine for more than 40 years.
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I have a pulsating/twitching neck vein between my collar ...

Customer Question

I have a pulsating/twitching neck vein between my collar bone and my jaw. It has happened off and on for about 3 days and can last for hrs. It seems to be associated with my pulse but it does not happen with each pulse, it is annoying, if I pull my neck up, it hurts. Is it something to be concerend about?
Submitted: 7 years ago.
Category: Health
Expert:  Doctor Nash replied 7 years ago.
Lori,

What you are seeing is the pulse from your heart beat reflected in the column of blood in your jugular vein, a jugular pulse.

If you are on the thin side, do not have swollen ankles, and are not short of breath, this is probably not of concern. However, I should add that if it is apparant when you are sitting or standing up, you should see your physician as soon as possible.

Now, the fact that it is not associated with each heart beat makes me suspiscious that you may have an abnormality of heart rhythm, another reason to see you physician soon.

If you notice the pulsation while lying down or notice any of the things I mentioned above, this can be an emergency and reason to go to an ER.

Let me know if you want to "talk" about this. I teach medicine, so I am not available at all times. However, I do check this site throughout the day. Please be patient; I will reply.

Dr. Nash
Customer: replied 7 years ago.
It happens for like 3/4 hrs fairly consistantly whether I am sitting,standing or lying. It is like a pulse I can feel and see in the mirror and it seems to travel up and down that vein. I recently had an ecco and was told nothing was wrong. this happened for a few hrs a few days ago, then yesterday morn for a few hrs and now all afternoon and evening today. I also have a headache that comes and goes but that was only today. I want to say that the area feels kind of tight in my neck on the left side by my collar bone.
Expert:  Doctor Nash replied 7 years ago.
Lori,

I think you are having an abnormality of heartt rhythm we call premature ventricular contractions (PVCs). These may be entirely benign, but you are entering the age group in which nothing should be ignored.

Clich here to go to a web page that describes PVCs and explains how they should be evaluated.

These may not occur during a routine EKG run. If not, you should have a 24- or 48-hour Holter monitor study.

Both you and I will feel better if you talk with your physician about this. The Echo was reasuring in regard to cardiac structure and function, but if you were not having these PVCs during that study, they could not be observed.

Frank Nash

Doctor Nash, Professor of Medicine (MD)
Category: Health
Satisfied Customers: 616
Experience: I've been teaching and practicing medicine for more than 40 years.
Doctor Nash and 7 other Health Specialists are ready to help you
Expert:  Doctor Nash replied 7 years ago.
Lori,

Thanks for accepting — and even more for telling me that you have PVCs. Let me build upon that.

Now, I want you to know that most PVCs are NOT felt. Whether or not one is sensed depends upon the timing between the regular beats and the PVC. The PVC "blocks" the next regular beat. If the time to the next beat is short, i.e. the filling time of the ventricle is short, the PVC will not be noticed because it will not eject a lot of blood; if it is long, more blood will enter the ventricle, more blood is ejected, and the next beat will be forceful — you will feel it and see it in the jugular pulse.

As a result, it is very common for people who have routine EKGs to be shocked when told that the tracing showed PVCs. Boy, does that cause anxiety, and we have to work to calm the patient because most of the PVC occur in normal hearts (even the ones that are symptomatic) and are benign.

I hope that this clarifies the issue for you. If you had not told me about the PVCs in your feedback, I would not have taken the opportunity to fill you in.

I'm taking the liberty of asking you to use the feedback mechanism again to tell me if this added information helps.

Frank Nash
Customer: replied 7 years ago.
Reply to Doctor Nash's Post: I do feel my PVC's which is what made me go into the ER in the first place and have since had a halter monitor and an echo. Unfortunately,I did not have PVC's during either test. The ER dr. wanted to put me on beta blocker and I wanted to check into further from the EKG which does show them. I can tell when they about to happen too, they mostly happen while laying down right before bed. This seemes different though, its constant almost like an eye twitch but I can see it bulging in my neck, It feels bubbly and it starts to hurt after some time and makes the area above the collar bone feel tight. It is very weird, it will go on for hrs, then stop and start whenever. This is the forth day, not in a row I have had it. Today it was light. Yesterday it was all day and night. People can see the vein throbbing. It gets concerning.
Expert:  Doctor Nash replied 7 years ago.
Lori,

I took the liberty of calling Dr. Morton E. Tavel, a long-time classmate and colleague, about your problem. He is a cardiologist who "wrote the book(s)" on interpretation of peripheral pulses. Yes, he's another Professor.

He agrees that these are probably PVCs and that you must see a good internist or cardiologist while having one of these episodes. That is the only way in which you can resolve the issue.

The disconcerting thing for both of us is that the pulse can be seen while you are reclining, but that is not enough to alter the impression. All of this is based upon the premise that you are in all ways healthy, with no structural heart disease and the pulsation is venous.

I hope that you will see someone soon for a hands-on evaluation, and then let me know the result. I am always limited in what I can do through the web and do appreciate follow-up.

Thanks for returning for this additional discussion.

Frank Nash

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