Clinical estimation of the jugular venous pressure (JVP) has been at the heart of bedside cardiology for the past 100 years. Observation and description of the waveform used to be central to the derivation of a clinical diagnosis. As technology has rapidly developed over the past 25 years, the bedside method of JVP estimation and description has all but disappeared. But need it be abandoned? The conditions, which today cause an elevated JVP, are very different from those that were prevalent three decades ago. Rheumatic valve disease has all but disappeared in the UK, but heart failure caused by myocardial disease is now much more common. The outlook for patients with unoperated congenital heart disease was poor, but diagnostic and surgical advances in the last 50 years have made survival commonplace. Lifelong surveillance is required in all but the simplest cases.