What is considered a positive finding in the hepatojugular reflux test?

In the assessment of heart failure, the hepatojugular reflux test is utilized to evaluate the presence of right heart dysfunction and fluid overload. A positive finding in this test is indicated by a significant increase in jugular venous pressure (JVP) when pressure is applied to the liver area.

An increase of 3 cm in JVP is commonly accepted as a threshold for a positive result in this test. This level of increase suggests that venous congestion is present, consistent with conditions such as heart failure. The mechanism behind this is that applying pressure to the liver increases the venous return to the heart, which can lead to a rise in JVP if the right heart is unable to accommodate the increased blood volume due to dysfunction. This can reflect poor right ventricular compliance or elevated right atrial pressure.

While any increase in JVP may be noteworthy, smaller increments like 1 cm or 2 cm are not typically indicative of significant heart dysfunction or fluid overload and may occur in many normal physiological states. Conversely, a much larger increase, such as 5 cm, could indicate substantial fluid overload but is not the established threshold in routine clinical assessments and may lead to over-diagnosis of right heart failure. Therefore, an increase of 3