Q: In patients with significant tricuspid regurgitation (TR), the pulsatility of the liver may correspond to which part of central venous pressure (CVP)?
A) a waves
B) c waves
C) v waves
D) x descent
E) y descent
Answer: C (v waves)
Hepatojugular reflux is an excellent physical sign. Primarily it helps to differentiate cardiac causes of hepatic insufficiency from primary hepatic parenchymal diseases. In patients with significant TR, the liver is usually pulsatile and correspond with pre-systole pulsation i.e. v wave on CVP tracing. And, if this liver pulsatility is lost, it signifies cardiac cirrhosis.
#physical-exam
#cardiology
#hepatology
Reference:
Ma TS, Bozkurt B, Paniagua D, Kar B, Ramasubbu K, Rothe CF. Central venous pressure and pulmonary capillary wedge pressure: fresh clinical perspectives from a new model of discordant and concordant heart failure. Tex Heart Inst J. 2011; 38(6):627-38.
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