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The hepatojugular reflux is a reliable but neglected physical sign which appears earlier in the course of congestive heart failure than the conventional signs and symptoms. In 1885, Pasteur originally described this sign as a manifestation of tricuspid regurgitation. However, experience has shown that it is present with heart failure of all etiologies.
The hepatojugular reflux, as presently defined, consists of a distention of the neck veins when pressure is applied over the liver. With a competent heart, pressure on the liver does not elevate the venous blood level in the neck veins when the subjects are in the semirecumbent position. The competent heart promptly increases its output, in response to an increase in venous return, and thus prevents a rise in general venous pressure. In the presence of congestive heart failure, pressure applied to the liver causes a sustained rise of the venous pressure that is prominently reflected by
Bryant JM. THE HEPATO-JUGULAR REFLUXA HELPFUL SIGN IN THE DIAGNOSIS AND TREATMENT OF CONGESTIVE HEART FAILURE. JAMA. 1957;165(3):281–284. doi:10.1001/jama.1957.72980210023024
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