Efficacy of the Hepatojugular Reflux Test
Faculty Advisor Name
Abby Massey
Department
Department of Health Professions
Description
Congestive heart failure, CHF, can often be evaluated with the hepatojugular reflux (HJR) test and other clinical assessments without the need for invasive testing. The objective of this paper is to evaluate the correlation of a positive HJR test with elevated right heart pressures measured by cardiac catheterization, predictors of CHF.
The hepatojugular reflux test is a physical exam maneuver that demonstrates peripheral congestion common in CHF due to an increased pressure in the right side of the heart. The HJR test is performed by first measuring the jugular venous pressure of a patient at baseline. This is done by identifying the flutter of the internal jugular vein in the neck, placing a ruler vertically at the sternal angle, and using a straight edge set at the level of the internal jugular vein to assess the height of that vein from the sternal angle. This measurement is a reflection of right atrial pressure. The next step in the test is the application of pressure over the liver for about 10 seconds while the patient lies supine at a 45° angle and measuring the jugular venous pressure a second time. An increase in jugular venous pressure by more than 3 cm is considered a positive result. This test indicates that the right ventricle cannot accommodate an increased venous return, and has been shown to significantly relate with pulmonary capillary wedge pressure, central venous pressure, and right atrial pressures. These pressures are measured directly through cardiac catheterization, an invasive test requiring close monitoring. Increases in these pressures are consistent with decreased right ventricular function and peripheral congestion as seen in CHF.
The gold standard in diagnosing CHF is a hemodynamic exercise test which measures PCWP through cardiac catheterization both at rest and with exercise. Given the primary importance of clinical assessment in the diagnosis of CHF, this study focuses on the efficacy of the hepatojugular reflux test in assessing right heart pressures and severity of CHF. This bedside test can provide important information about a patient’s status and prognosis immediately and without extra cost. We compare the efficacy of the HJR test to that of cardiac catheterization in diagnosing CHF in adults over 45 years of age.
PubMed was utilized to identify studies focused on assessing the efficacy of the HJR by comparing estimated pressures to catheterization obtained pressures. This yielded three studies by Sochowski et al, Ducas et. al, and Butman et al. In conclusion, The HJR test has a clinically significant sensitivity and specificity for predicting elevated hemodynamic pressures. The HJR test is a clinically useful bedside test that should be used in conjunction with physical exam, history, and laboratory and imaging data.
Efficacy of the Hepatojugular Reflux Test
Congestive heart failure, CHF, can often be evaluated with the hepatojugular reflux (HJR) test and other clinical assessments without the need for invasive testing. The objective of this paper is to evaluate the correlation of a positive HJR test with elevated right heart pressures measured by cardiac catheterization, predictors of CHF.
The hepatojugular reflux test is a physical exam maneuver that demonstrates peripheral congestion common in CHF due to an increased pressure in the right side of the heart. The HJR test is performed by first measuring the jugular venous pressure of a patient at baseline. This is done by identifying the flutter of the internal jugular vein in the neck, placing a ruler vertically at the sternal angle, and using a straight edge set at the level of the internal jugular vein to assess the height of that vein from the sternal angle. This measurement is a reflection of right atrial pressure. The next step in the test is the application of pressure over the liver for about 10 seconds while the patient lies supine at a 45° angle and measuring the jugular venous pressure a second time. An increase in jugular venous pressure by more than 3 cm is considered a positive result. This test indicates that the right ventricle cannot accommodate an increased venous return, and has been shown to significantly relate with pulmonary capillary wedge pressure, central venous pressure, and right atrial pressures. These pressures are measured directly through cardiac catheterization, an invasive test requiring close monitoring. Increases in these pressures are consistent with decreased right ventricular function and peripheral congestion as seen in CHF.
The gold standard in diagnosing CHF is a hemodynamic exercise test which measures PCWP through cardiac catheterization both at rest and with exercise. Given the primary importance of clinical assessment in the diagnosis of CHF, this study focuses on the efficacy of the hepatojugular reflux test in assessing right heart pressures and severity of CHF. This bedside test can provide important information about a patient’s status and prognosis immediately and without extra cost. We compare the efficacy of the HJR test to that of cardiac catheterization in diagnosing CHF in adults over 45 years of age.
PubMed was utilized to identify studies focused on assessing the efficacy of the HJR by comparing estimated pressures to catheterization obtained pressures. This yielded three studies by Sochowski et al, Ducas et. al, and Butman et al. In conclusion, The HJR test has a clinically significant sensitivity and specificity for predicting elevated hemodynamic pressures. The HJR test is a clinically useful bedside test that should be used in conjunction with physical exam, history, and laboratory and imaging data.
