Q: Positive elucidation of HEPATOJUGULAR REFLUX is roughly equivalent to what level of pulmonary wedge pressure?


Answer: About 15 mm Hg or higher

HEPATOJUGULAR REFLUX, also called abdominojugular test, is a one lost simple bedside maneuver. The hepatojugular reflux is assessed by applying sustained pressure for 15 seconds over the upper abdomen as patient breathes normally. Usual Jugular Venous Pressure (JVP) is about 1 to 3 cm increase, but with right ventricle (RV) failure, it exceeds above 3 cm. This is due to increase preload secondary to increase venous return with manually induced intraabdominal pressure. A raised diaphragm may also plays a part. Interestingly, in left ventricular failure, a positive hepatojugular reflux has been demonstrated to be equivalent of about 15 mm Hg or higher of pulmonary capillary wedge pressure in patients. Elucidation of hepatojugular reflex in left ventricular failure is hard to explain but hypothesis is impaired right ventricular compliance with left heart failure.



Reference: 

 Ewy GA. The abdominojugular test: technique and hemodynamic correlates. Ann Intern Med 1988; 109:456.