Hepatojugular reflux: Difference between revisions
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'''''Synonyms and keywords:''''' Abdominojugular test, AJR, HJR | |||
==Overview== | ==Overview== | ||
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The [[internal jugular vein]] can be distinguished from the [[carotid artery]] by | The [[internal jugular vein]] can be distinguished from the [[carotid artery]] by | ||
* | * Having a biphasic waveform | ||
* | * Falling pressure during inspiration | ||
* | * Rising with abdominal pressure, and | ||
* | * Being compressible with direct pressure <ref name="pmid8594245">.</ref>. | ||
When the meniscus of the internal jugular vein cannot be determined, one study found the height of the meniscus in the external jugular vein correlated with the right atrial pressure <ref name="pmid4698149">{{cite journal |author=Stoelting R |title=Evaluation of external jugular venous pressure as a reflection of right atrial pressure |journal=Anesthesiology |volume=38 |issue=3 |pages=291-4 |year=1973 |pmid=4698149}}</ref>. <gallery>Image:Gray558.png</gallery> | When the meniscus of the internal jugular vein cannot be determined, one study found the height of the meniscus in the external jugular vein correlated with the right atrial pressure <ref name="pmid4698149">{{cite journal |author=Stoelting R |title=Evaluation of external jugular venous pressure as a reflection of right atrial pressure |journal=Anesthesiology |volume=38 |issue=3 |pages=291-4 |year=1973 |pmid=4698149}}</ref>. <gallery>Image:Gray558.png</gallery> | ||
* On an otherwise healthy individual, the jugular venous pressure remains constant or temporarily rises for a [[Heart rate|heartbeat]] or two, before returning to normal. This ''negative result'' would be indicated by a lack of swelling of the jugular vein. | * '''Negative Result:''' On an otherwise healthy individual, the jugular venous pressure remains constant or temporarily rises for a [[Heart rate|heartbeat]] or two, before returning to normal. This ''negative result'' would be indicated by a lack of swelling of the jugular vein. | ||
* A ''positive result'' is variously defined as either a sustained rise in the JVP of at least 4cm or more <ref name="pmid8594245">.</ref> or a fall of 4 cm or more <ref name="pmid3415106">.</ref> after the examiner releases pressure. The AJR has a reported [[sensitivity (tests)|sensitivity]] of 24% <ref name="pmid2182296">{{cite journal |author=Marantz P, Kaplan M, Alderman M |title=Clinical diagnosis of congestive heart failure in patients with acute dyspnea |journal=Chest |volume=97 |issue=4 |pages=776-81 |year=1990 |pmid=2182296}}</ref> to 72% <ref name="pmid3415106">.</ref> and a [[specificity (tests)|specificity]] of 96% to 93%. The large discrepancy in sensitivity may be explained by the higher value being reported during performance in optimal conditions of a cardiac lab while the lower value was from a study in an emergency room. | * '''Positive Result:''' A ''positive result'' is variously defined as either a sustained rise in the JVP of at least 4cm or more <ref name="pmid8594245">.</ref> or a fall of 4 cm or more <ref name="pmid3415106">.</ref> after the examiner releases pressure. The AJR has a reported [[sensitivity (tests)|sensitivity]] of 24% <ref name="pmid2182296">{{cite journal |author=Marantz P, Kaplan M, Alderman M |title=Clinical diagnosis of congestive heart failure in patients with acute dyspnea |journal=Chest |volume=97 |issue=4 |pages=776-81 |year=1990 |pmid=2182296}}</ref> to 72% <ref name="pmid3415106">.</ref> and a [[specificity (tests)|specificity]] of 96% to 93%. The large discrepancy in sensitivity may be explained by the higher value being reported during performance in optimal conditions of a cardiac lab while the lower value was from a study in an emergency room. | ||
'''Below is a video demonstrating hepato-jugular reflux''' | '''Below is a video demonstrating hepato-jugular reflux''' | ||
{{#ev:youtube|B8OX3T4c7PU}}> | |||
==References== | ==References== | ||
{{Reflist}} | {{Reflist|2}} | ||
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[[Category:Signs and symptoms]] | [[Category:Signs and symptoms]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Emergency room]] | |||
[[Category:Intensive care medicine]] | |||
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Latest revision as of 21:04, 6 September 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Abdominojugular test, AJR, HJR
Overview
The abdominojugular test (AJR), also known as hepatojugular reflux or HJR is used as an alternate test for measuring jugular venous pressure (JVP) through the distension or swelling of the jugular vein. A positive AJR best correlates with the pulmonary capillary wedge pressure although it also correlates with the right heart pressure and the left heart ejection fraction [1].
Procedure
The doctor presses firmly over either the Right upper quadrant (liver) or over the center of the abdomen [1] for 10-60 seconds with a pressure of 20 to 35 mm Hg while observing the internal jugular vein in the neck and also observing to be sure the patient does not Valsalva [2].
The internal jugular vein can be distinguished from the carotid artery by
- Having a biphasic waveform
- Falling pressure during inspiration
- Rising with abdominal pressure, and
- Being compressible with direct pressure [2].
When the meniscus of the internal jugular vein cannot be determined, one study found the height of the meniscus in the external jugular vein correlated with the right atrial pressure [3].
- Negative Result: On an otherwise healthy individual, the jugular venous pressure remains constant or temporarily rises for a heartbeat or two, before returning to normal. This negative result would be indicated by a lack of swelling of the jugular vein.
- Positive Result: A positive result is variously defined as either a sustained rise in the JVP of at least 4cm or more [2] or a fall of 4 cm or more [1] after the examiner releases pressure. The AJR has a reported sensitivity of 24% [4] to 72% [1] and a specificity of 96% to 93%. The large discrepancy in sensitivity may be explained by the higher value being reported during performance in optimal conditions of a cardiac lab while the lower value was from a study in an emergency room.
Below is a video demonstrating hepato-jugular reflux {{#ev:youtube|B8OX3T4c7PU}}>
References
- ↑ 1.0 1.1 1.2 1.3 Ewy G (1988). "The abdominojugular test: technique and hemodynamic correlates". Ann Intern Med. 109 (6): 456–60. PMID 3415106.
- ↑ 2.0 2.1 2.2 Cook D, Simel D (1996). "The Rational Clinical Examination. Does this patient have abnormal central venous pressure?". JAMA. 275 (8): 630–4. PMID 8594245.
- ↑ Stoelting R (1973). "Evaluation of external jugular venous pressure as a reflection of right atrial pressure". Anesthesiology. 38 (3): 291–4. PMID 4698149.
- ↑ Marantz P, Kaplan M, Alderman M (1990). "Clinical diagnosis of congestive heart failure in patients with acute dyspnea". Chest. 97 (4): 776–81. PMID 2182296.