The abdominojugular test, also called the hepatojugular reflux test may be a helpful bedside procedure. It is especially useful when right heart failure is suspected in a patient whose central venous pressure is normal. Firm pressure is applied to the abdomen. This results in an increased venous return to the right ventricle. The dysfunctioning right ventricle cannot accept the increase in blood volume without a rise in filling pressure. This rise is transmitted to the neck veins and results in an increase in central venous pressure.
Technique
The technique for carrying out the abdominojugular test should be performed in the standardized fashion. First, instruct the patient to breathe normally. Second, observe the baseline level of the central venous pressure in the jugular veins in the neck. Next, compress the upper abdomen with the palm of the hand for ten seconds or more. Finally, observe any change that has occurred in the level of the central venous pressure.
Normal vs. abnormal
The normal response to the abdominojugular test is seen during abdominal compression. There is either no rise in central venous pressure or a rise that returns to the baseline. An abnormal response is seen during and after compression. During compression, there is a rise in central venous pressure and after compression there is a fall of 4 cm or more. In patients with chronic left heart failure that often results in right heart failure, the abdominojugular test is commonly positive.
Demonstration
The following demonstration of a positive abdominojugular test is presented through the courtesy of Dr. Gordon A. Ewy and was carried out at the University of Arizona.
Now, let's look at our neck vein here and seen the venous pulsation about at that level (pointing at it), and what I am going to do is press on her "tummy" and ask her to breathe normally, not to strain back, now breathe normally, breathe normally, breathe normally... See the increased height of the venous pressure? Brethe normally... and then I'm going to let go... Now. And you can see drop of the venous pressure.