Hepatojugular Reflux
Other Names
- Hepatojugular Reflux (HJR)
- Hepatojugular Reflux Test
- Hepatojugular Reflex
- Abdominojugular Reflux (AJR)
- Abdominojugular Reflux Test
Purpose
- Assess right-sided cardiac function and filling pressures
- Identify systemic venous congestion and volume overload
- Complement jugular venous pressure (JVP) assessment
Description
- The patient is positioned at 30–45° with the neck relaxed and the internal jugular venous pulse visible
- Firm, continuous pressure is applied over the right upper quadrant (liver) or mid-abdomen for 10–30 seconds
- The examiner observes the height of the jugular venous pulsation throughout the maneuver
- Positive test
- Defined as a sustained increase in JVP of ≥3 cm
- Persists during abdominal compression and returns toward baseline after pressure is released.
- A brief, transient rise in JVP lasting only a few seconds is considered a normal physiological response.
Pathology
- Right-sided heart failure
- Congestive heart failure
- Pulmonary hypertension with right ventricular dysfunction
- Constrictive pericarditis
- Restrictive cardiomyopathy
- Tricuspid regurgitation
- Hypervolemic states with elevated central venous pressure
Evidence
Congestive Heart Failure
- Iwata et al[3]
- Sensitivity: 12-24%
- Specificity: 95-96%
Elevated Right Atrial Pressure
- Sochowski et al with pressure > 9 mm Hg by catheterization[4]
- Sensitivity: 100%
- Specificity: 85%
Elevated Right Ventricular End Diastolic Pressure
- Sochowski et al > 12 mm Hg[4]
- Sensitivity: 90%
- Specificity: 89%
See Also
References
- ↑ Chen Y, Zang W, Zhong H, Deng X, Zhong W, Wang L, Chen X. Response to two Janus kinase inhibitors in a boy with SAVI during 2-year follow-up: case report and literature review. Front Immunol. 2025;16:1615075. Published July 8, 2025. doi:10.3389/fimmu.2025.1615075
- ↑ Fischer EA, Barajas R, Kalam KA, Rao SJ, Chou J, Calderon LM, Weisman DS. The ultrasound hepato-jugular reflux: measuring the hepato-jugular reflux with ultrasound with comparison to invasive right heart catheterization. Am J Med. 2024;137(6):545-551.e6. doi:10.1016/j.amjmed.2024.02.019.
- ↑ Iwata H, Miwa Y, Ikehara Y, Yodoshi T, Ueda S. The clinical value of hepatojugular reflux on congestive heart failure: A meta-analysis. J Gen Fam Med. 2022 Aug 19;23(6):393-400. doi: 10.1002/jgf2.574. PMID: 36349209; PMCID: PMC9634136.
- ↑ 4.0 4.1 Sochowski RA, Dubbin JD, Naqvi SZ. Clinical and hemodynamic assessment of the hepatojugular reflux. Am J Cardiol. 1990 Oct 15;66(12):1002-6. doi: 10.1016/0002-9149(90)90940-3. PMID: 2220606.
Created by:
John Kiel on 6 July 2026 13:37:10
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Last edited:
6 July 2026 13:56:43
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