The abdominojugular reflux sign.
OBJECTIVE
The abdominojugular reflux sign is useful in diagnosing right ventricular failure, but is often performed and interpreted incorrectly. Our objective was to review the history, epidemiology, and pathophysiology of the abdominojugular reflux sign.


METHODS
We conducted a MEDLINE search of the English language reports published between 1966 and 1999 and a manual search of bibliographies of relevant papers.


RESULTS
A positive abdominojugular reflux sign is defined by an increase in the jugular venous pressure of greater than 3 cm, sustained for greater than 15 seconds. In the absence of left heart failure, a positive abdominojugular reflux sign should prompt consideration of impaired right ventricular preload, a decrease in right ventricular compliance, a decrease in right ventricular systolic function or an elevation in right ventricular afterload. In patients presenting with dyspnea, the abdominojugular reflux is useful in predicting congestive heart failure (LR+ 6.0 (95% CI; 0.8-51); LR- 0.78; (95% CI: 0.62 to 0.98)) and suggests pulmonary capillary wedge pressures of greater than 15 mm Hg (LR+ 6. 7 (95% CI: 3.3 to 13.4); LR- 0.08 (95% CI: 0.01 to 0.52)).


CONCLUSIONS
The abdominojugular reflux is not specific to any one disorder, but rather is a reflection of a right ventricle that cannot accommodate augmented venous return. Constrictive pericarditis, right ventricular infarction, and restrictive cardiomyopathy are common causes of a positive finding. Left ventricular failure may also induce the sign, but only when the pulmonary capillary wedge pressure is greater than 15. The one diagnosis not seen with abdominojugular reflux is cardiac tamponade.
General Internal Medicine Section, VA Medical Center, San Francisco, California 94121, USA.
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J
Wiese
D000005:Abdomen / Q000503:physiopathology*; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D007601:Jugular Veins / Q000503:physiopathology*; D009200:Myocardial Contraction; D011312:Pressure; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D014690:Venous Pressure / Q000502:physiology*; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000503:physiopathology*