Physical Exam

Abdominojugular Reflux

also known as Hepatojugular reflux

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Video coming September 2026

How to Perform

With the patient reclining at about 45° and the jugular pulsation visible, apply firm, steady pressure over the mid-abdomen for 10–15 seconds while the patient breathes normally, and watch the neck veins. A positive test is a sustained rise in the jugular venous pressure (more than about 3 cm) that persists throughout compression and falls when you release.

How to Interpret

Heart Failure

Abdominojugular reflux positive

Rule in

Somewhat helpful

Rule out

—

Evidence:Strong

Tricuspid Regurgitation

Abdominojugular reflux positive

Rule in

—

Rule out

Somewhat helpful

Evidence:Limited

References

Iwata H, Miwa Y, Ikehara Y, Yodoshi T, Ueda S. The clinical value of hepatojugular reflux on congestive heart failure: A meta-analysis. J Gen Fam Med. 2022;23(6):393-400. doi:10.1002/jgf2.574. PMID: 36349209. Open access (CC BY-NC-ND) via Wiley Online Library and PMC9634136. PRISMA-compliant systematic review with QUADAS-2 quality assessment; prospective protocol registration with PROSPERO (CRD42020215004); 7 included studies (n=5,195 total participants); bivariate random-effects model and HSROC analysis. Supersedes the Wiese 2000 narrative review (Am J Med 109(1):59-61, PMID 10936479) for purposes of clinical-CHF diagnostic accuracy: Wiese 2000 was a MEDLINE-search-plus-bibliography-search narrative review without PRISMA/QUADAS/formal pooling, and Wiese's headline LR+ 6.7 (CI 3.3-13.4) was reported for invasively-measured PCWP > 15 mm Hg in patients presenting with dyspnea, not for clinical CHF as the reference standard.
Maisel AS, Atwood JE, Goldberger AL. Hepatojugular reflux: useful in the bedside diagnosis of tricuspid regurgitation. Ann Intern Med. 1984;101(6):781-2. PMID: 6497192.
Ewy GA. The abdominojugular test: technique and hemodynamic correlates. Ann Intern Med. 1988;109(6):456-460.