Abdominojugular test
The abdominojugular test (AJR), also known as hepatojugular reflux, is used as an alternate test for measuring jugular venous pressure (JVP) through the distension or swelling of the jugular vein. A positive AJR best correlates with the pulmonary capillary wedge pressure although it also correlates with the right heart pressure and the left heart ejection fraction [1].
Procedure
The doctor presses firmly over either the Right Upper Quadrant (liver) or over the center of the abdomen [1] for 10-60 seconds with a pressure of 20 to 35 mm Hg while observing the internal jugular vein in the neck and also observing to be sure the patient does not Valsalva [2]. The internal jugular vein can be distinguished from the carotid artery by 1) having a biphasic waveform 2) falling pressure during inspiration 3) rising with abdominal pressure, 4) increasing and decreasing with lowering and elevation of the head of the bed, respectively, and 5) being compressible with direct pressure [2]. When the meniscus of the internal jugular vein cannot be determined, one study found the height of the meniscus in the external jugular vein correlated with the right atrial pressure [3].
- On an otherwise healthy individual, the jugular venous pressure remains constant or temporarily rises for a heartbeat or two, before returning to normal. This negative result would be indicated by a lack of swelling of the jugular vein.
- A positive result is variously defined as either a sustained rise in the JVP of at least 4cm or more [2] or a fall of 4 cm or more [1] after the examiner releases pressure. The AJR has a reported sensitivity of 24% [4] to 72% [1] and a specificity of 96% to 93%. The large discrepancy in sensitivity may be explained by the higher value being reported during performance in optimal conditions of a cardiac lab while the lower value was from a study in an emergency room.
References
- ↑ 1.0 1.1 1.2 1.3 Ewy G (1988). "The abdominojugular test: technique and hemodynamic correlates". Ann Intern Med 109 (6): 456-60. PMID 3415106.
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<ref>tag; name "pmid8594245" defined multiple times with different content Cite error: Invalid<ref>tag; name "pmid8594245" defined multiple times with different content - ↑ Stoelting R (1973). "Evaluation of external jugular venous pressure as a reflection of right atrial pressure". Anesthesiology 38 (3): 291-4. PMID 4698149.
- ↑ Marantz P, Kaplan M, Alderman M (1990). "Clinical diagnosis of congestive heart failure in patients with acute dyspnea". Chest 97 (4): 776-81. PMID 2182296.