Testing the Hepatojugular Reflux - Clinical Examination

Testing the hepatojugular reflux is beneficial for diagnosing cardiac insufficiency, particularly when typical signs like edema are missing. The test aims to manually increase the volume load on the right side of the heart by mobilizing blood from the abdominal cavity.

Before starting the test, observe the position and volume of the jugular veins with the patient lying down, as this position offers the best visibility. Subsequently, elevate the upper body to about 45 degrees until the jugular veins' contour disappears.

To perform the test, apply moderate pressure for approximately one minute just under the right ribcage. This action mobilizes blood from the abdominal area, increasing venous return.

A positive reflux is indicated by distention of the jugular veins as blood builds up. In healthy individuals, distention may be brief as the heart increases outflow. Persistent jugular vein distension and pulsation, however, can suggest congestion before the right side of the heart, potentially indicating heart failure.