Hepatojugular Reflux

Hepatojugular reflux (abdominojugular test) is a bedside assessment technique that evaluates right ventricular function and volume status by applying firm, sustained pressure over the right upper quadrant or mid-abdomen for 15-30 seconds while observing the jugular venous pressure (JVP). In a normal heart, the transient increase in venous return from abdominal compression is easily accommodated by the right ventricle, and JVP rises only transiently before returning to baseline. In right ventricular dysfunction or hypervolemia, the right ventricle cannot handle the increased preload, causing sustained JVP elevation (greater than 3 cm rise) throughout the duration of abdominal compression — a positive test. This reflects right ventricular systolic dysfunction, tricuspid regurgitation, constrictive pericarditis, or significant volume overload. The positive test correlates with elevated pulmonary capillary wedge pressure greater than 15 mmHg and is useful in differentiating cardiac from non-cardiac causes of peripheral edema. The nurse positions the patient at 45 degrees, identifies the internal jugular vein pulsation, performs the test using steady mid-abdominal pressure while the patient breathes normally, interprets the response, correlates findings with other signs of heart failure, and communicates...