Hepatojugular reflux and Kussmaul sign
DeGowin's Diagnostic Examination, 9/e, p.387
These phenomena are caused by inability of the right heart to accommodate increased venous return.
Position the patient so the blood column is just visible in the jugular veins above the clavicle.
With the patient breathin normally, place the right hand on the right upper abdominal quadrant and press firmly upward under the costal margin for at least 10-15 seconds.
The hepatojugular reflux sign is present if the top of the jugular venous column in the neck rises and persists as long as the abdominal pressure is continued.
Kussmaul sign is present when the jugular venous column fails to collapse during inspiration due to increased intraabdominal pressure created by the diaphragm during inspiration.
The hepatojugular reflux sign is most commonly seen with eearly right heart fialure.
Both signs may be seen with severe right heart failure, constrictive pericarditis, and right ventricular infarction.
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