Evaluate the Hepatojugular Reflux

A useful test in assessing high jugular venous pressure is that of the hepatojugular reflux, also known as abdominal compression. By applying pressure over the liver, the examiner can grossly assess right ventricular function. Patients with right ventricular failure have dilated sinusoids in the liver. Pressure on the liver pushes blood out of these sinusoids and into the inferior vena cava and right side of the heart, causing further distention of the neck veins. The procedure is performed with the patient lying in bed, mouth open, breathing normally;this prevents a Valsalva maneuver. The examiner places his or her right hand over the patient's liver in the right upper quadrant and applies a firm, progressive pressure. Compression is maintained for 10 seconds. The normal response is for the internal and external jugular veins to show a transient increase in distention during the first few cardiac cycles, which is followed by a fall to baseline levels during the later part of the compression. In patients with right ventricular failure or elevated pulmonary artery wedge pressure, the neck veins remain distended during the entire period of compression;this distention diminishes rapidly (at least 4 cm) on sudden release of the compressing hand. If the examination is incorrectly performed with the patient's mouth closed, a Valsalva maneuver results and produces inaccurate results of the hepatojug-ular reflux test.

Like most other clinical maneuvers, the hepatojugular reflux test must be performed in a standardized manner. If performed correctly, this test can be of considerable value in the bedside assessment of the patient. The test result correlates best with the pulmonary artery

wedge pressure and, as such, is a reflection of increased central blood volume. Ewy (1988) evaluated this test and showed that in the absence of right ventricular failure, a positive test result is suggestive of a pulmonary artery wedge pressure of 15 mm Hg or greater.

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