Clinical exam · Cardiovascular system
Hepatojugular (abdominojugular) reflux !
- Maneuver
Pressing the abdomen gently and steadily and watching whether the neck vein rises and stays up shows whether the right heart can take more blood.
Updated 2026-11-01
See it in 3D: Internal jugular vein · Liver · Inferior vena cava · Right atrium · Right ventricle
What it is
It is a volume challenge for the right heart. Abdominal pressure pushes blood toward the right atrium; a healthy heart handles it within a few beats, a failing one does not. It helps confirm heart failure when the resting jugular pressure is equivocal.
The anatomy it tests
- Abdominal compression shifts blood from the splanchnic bed and the liver through the inferior vena cava into the right atrium and ventricle.
- A well-functioning right ventricle raises its output and the jugular returns to baseline within a few beats.
- If the right ventricle cannot take the load, or left-sided filling pressures are high, the jugular column rises and stays up.
How to do it
- Patient lying with the head of the bed at 30–45 degrees, as for jugular pressure, and the top of the pulsation identified.
- Explain the maneuver and ask the patient to breathe normally, without straining or holding the breath.
- Place the palm on the middle of the abdomen (periumbilical or right upper quadrant) and press firmly and steadily for about 10 to 15 seconds.
- Watch the jugular throughout the compression and on release.
- Record how many centimeters it rises and whether the rise is sustained while pressure is held.
What a positive result means
- Positive: a sustained rise in jugular pressure of about 3 cm or more during compression, falling abruptly on release.
- Suggests heart failure (right-sided or with high left filling pressures), constrictive pericarditis, restrictive cardiomyopathy or tricuspid regurgitation.
- A brief rise that returns to baseline within a few beats is normal.
- A negative test does not exclude compensated or treated heart failure.
Usefulness and limits
- False positive if the patient strains (Valsalva) or the pressure is painful.
- Avoid in a tender abdomen or suspected abdominal aortic aneurysm.
- Interpret with the resting jugular pressure, edema, crackles and natriuretic peptides.
Test yourself
Think of the answer, then tap the question to see it.
When is hepatojugular reflux considered positive?
When jugular pressure rises about 3 cm or more and stays up for as long as abdominal compression lasts, then falls on release.
Why is the patient asked not to strain during the maneuver?
Valsalva raises intrathoracic and jugular pressure regardless of ventricular function and gives a false positive.
Which vein carries abdominal blood to the right atrium during the maneuver?
The inferior vena cava, which receives blood from the liver and the splanchnic bed.
See it in 3D
The structures of Durgical's 3D anatomy where it is found.
Related
- Jugular venous pressure and the venous pulse
- Heart failure syndrome: left- and right-sided signs
- Edema: pitting, grading and distribution
Related conditions
- Heart failure
- Constrictive pericarditis
- Restrictive cardiomyopathy (amyloid, sarcoid, haemochromatosis)
- Pulmonary hypertension and cor pulmonale
Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.
Sources: Heart failure: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026); 24.3 Nursing Assessment - Clinical Nursing Skills | OpenStax (OpenStax (Rice University), 2024); Mitral valve regurgitation: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026).
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Representative model, for educational purposes only.