Wednesday, May 10, 2017

Pathophysiology of hepatojugular reflux

Hello. Let's talk about the HJR today!

What is the hepatojugular reflux?
Distention of the neck veins when pressure is applied over the liver.


In which conditions is the hepatojugular reflex seen?
It is present in heart failure of all etiologies.

Historical side note: In 1885, Pasteur originally described this sign as a manifestation of tricuspid regurgitation.

What happens in a subject with a competent heart?
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.

What happens in congestive heart failure?
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 distension of the superficial and elevation of the pulsating level of the deep, neck veins.
An impaired heart is unable to respond to an increase in venous return by an increase in cardiac output, therefore, venous pressure rises.

Source: http://jamanetwork.com/journals/jama/article-abstract/321502

That's all!
Medicine is sooooo interesting < 3

-IkaN

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