Hepatojugular Reflux

Excerpt

Hepatojugular reflux, also known as abdominojugular reflux, is a classic bedside physical examination maneuver used to assess right-sided cardiac function and systemic venous congestion. A detailed history and physical examination have long served as the cornerstone of diagnosing and managing congestive heart failure (CHF); however, advances in noninvasive imaging over the past few decades have raised questions about the accuracy and clinical value of traditional examination findings. Despite these advances, simple bedside maneuvers, such as hepatojugular reflux, remain valuable adjuncts that can enhance diagnostic precision when interpreted in the appropriate clinical context.

First described by Pasteur in 1885 as a physical sign associated with tricuspid regurgitation, hepatojugular reflux exploits the hemodynamic response of the right atrium and ventricle to a transient increase in venous return induced by sustained abdominal pressure. In normal physiology, the right ventricle accommodates this preload without a sustained rise in right atrial pressure. In contrast, a positive hepatojugular reflux reflects impaired right ventricular compliance or elevated right-sided filling pressures.

Clinically, a positive hepatojugular reflux serves as a meaningful indicator of underlying cardiovascular pathology, most commonly CHF, pulmonary hypertension, and constrictive or restrictive pericardial disease. Beyond its diagnostic role, hepatojugular reflux provides prognostic information in patients with chronic heart failure and can help clinicians estimate volume status and guide therapy. When integrated with careful jugular venous examination and modern imaging modalities, hepatojugular reflux reinforces the importance of high-quality bedside assessment and remains relevant in contemporary cardiovascular practice.