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Medicine C.V.S ce32a52d

Positive hepatojugular reflux is found in all of the following conditions except-

A
Tricuspid regurgitation
B
Right hea failure
C
Decreased after load
D
Increased capillary bed pressure
High-Yield Explanation
Abdomino jugular reflex is mainly seen in impending right ventricular failure. JVP remains raised >3cm for >15sec HEPATOJUGULAR REFLUX --Raising the legs or abdominal compression increases venous return and pressure and facilitates analysis of the jugular venous pulse. --The hepatojugular or abdominojugular reflux is assessed by applying firm, sustained pressure for 10 to 15 seconds over the upper abdomen while the patient is breathing quietly. --In normal subjects this maneuver transiently increases jugular pressure by only approximately 1-3 cm. --In patients with right ventricular failure, however, sustained elevation of venous pressure usually greater than 3 cm is observed during continued compression (positive hepatojugular reflux). --It is assumed that a failing right ventricle is unable to respond normally to the increased preload caused by increased venous return with abdominal compression and elevated intraabdominal pressure++ a raised diaphragm during abdominal compression compromises cardiac filling by decreasing the intrathoracic and mediastinal volumes available for cardiac expansion. Ref: Harrisons 20th edition pg 1441

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