Which of the following statements is most accurate in describing hepatojugular reflux?
a. It is an accurate indicator of heart failure.
b. It is exaggerated in patients with right heart failure.
c. It is normal when patients are sitting up straight.
d. It should be absent in older patients with heart failure.
B
Hepatojugular reflux is used to evaluate right heart failure and is exaggerated when right heart failure is present. Use your hand and apply firm pressure to the abdomen in the midepigastric region while the patient breathes regularly. Observe the neck for increased jugular venous pres-sure (JVP) followed by an abrupt fall in JVP when the hand pressure is released. The JVP quickly returns to its true level between the abdominal hand pressure and release of the abdominal hand pressure.
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