Hepatojugular reflux

Hepatojugular reflux: Description, Causes and Risk Factors:Hepatojugular refluxAn elevation of venous pressure visible in the jugular veins and measurable in the veins of the arm, produced in active or impending congestive heart failure (CHF) and constrictive pericarditis by firm pressure with the flat hand over the abdomen often called hepatojugular reflux when pressure is exclusively over the liver.Causes and Risk Factors:Heart failure.
  • Constrictive pericarditis (JVP increases on inspiration - called Kussmaul's sign).
  • Cardiac tamponade.
  • Fluid overload, e.g. renal disease.
  • Superior vena cava obstruction (no pulsation).
Hepatojugular reflux can yield valuable information about cardiac function (especially of the right ventricle) and pulmonary function and is an important component of the assessment of volume status. The hepatojugular reflux is most commonly elevated with a raised venous pressure due to cardiac failure or hypervolaemia.In principle, the hepatojugular reflux reflects the height of the column of venous blood that rises above the physiologic zero point, which corresponds to the right atrium in humans.Symptoms:Symptoms may include:Getting tired very easily.
  • Fatigue and syncope.
  • Chest pain and angina.
  • Trouble breathing.
  • Trouble in breathing.
  • Heart murmur.
  • Weight gain.
Diagnosis:The hepatojugular maneuver may be performed as follows:The patient is positioned supine with elevation of the head at 45 degrees.
  • Look at jugular pulsations during quiet respirations (baseline JVP).
  • Apply gentle pressure (30-40 mmHg) over the right upper quadrant or middle abdomen for at least 10 seconds (some suggest to 1 minute).
  • Repeat the JVP.
  • An increase in JVP of >3 cm is a positive hepatojugular reflux test.
Practitionerexperienced in assessing hepatojugular reflux can gain further information by scrutinizing the hepatojugular reflux waveform.Treatment:The best treatment options will be decided by your physician. The osseous impingement of the dominant jugular vein can be relieved via a decompressive styloidectomy, and the clinical results can be excellent.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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