Evidence Base - Neck Veins Exam - Physical Diagnosis Skills - University of Washington School of Medicine

Heart Sounds & Murmurs

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Liver & Ascites

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[Neck Veins]

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Pulmonary

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Thyroid

Examination

• Jugular Venous Pressure

• Jugular Waveforms

• Demonstrations

Pathophysiology

Associated Evaluations

• Physical Exam

• Laboratory & Imaging

Differential Dx

• Measurement of Jugular Venous Pressure

• Hepatojugular Reflux (HJR)

• Cardiac Hemodynamics

[Skill Modules >> Neck & Veins Examination >> Evidence Base ]

Evidence Base: Neck Veins

Hepatojugular Reflux

The following tables depict the correlation of Hepatojugular Reflux (HJR) with diagnosing congestive heart failure (CHF).

HJR	CHF	No CHF
By Criteria
Present	5*	1*
Absent	18*	26*
	* Number of patients

Sensitivity of HJR 24%

Specificity of HJR 96%

Positive likelihood ratio of HJR 6.4 (95% CI 0.8 to 51)

Negative likelihood ratio of HJR 0.8 (95% CI, 0.6 to 1.0)

By Emergency Physicicans

By Criteria
HJR	CHF	No CHF
Present	4*	3*
Absent	8*	34*
	* Number of patients

Sensitivity of HJR 33%

Specificity of HJR 94%

Positive likelihood ratio of HJR 6.0 (95% CI 0.8 to 51)

Negative likelihood ratio of HJR 8% (95% CI, 0.6 to 1.0)

Adapted from Cook, et al