Page 76 - Clinical Pearls in Cardiology

64 Clinical Pearls in Cardiology

of JVP rises during inspiration. This paradoxical rise
in the upper level of JVP with inspiration is called as
the Kussmaul’s sign.
• Hepatojugular reflux sign: This sign is elicited by
applying slow and steady pressure with the palm of
the hand to the right upper quadrant of the abdomen
for about 15 seconds. A positive result is defined as a
sustained (i.e. more than 15 seconds) increase of at
least 4 cm in the jugular venous pressure. The test is
positive in conditions like early subclinical right heart
failure and tricuspid regurgitation.
5. What are Bernheim and ‘reversed’ Bernheim effects?
Bulging of a grossly hypertrophied interventricular
septum into the cavity of the right ventricle can cause a
reduction in the space available within the right ventricle.
This causes more resistance to right atrial emptying and
results in a large ‘a’ wave. This phenomenon is called as
Bernheim effect.
Normally, the decrease in intrathoracic pressure
during inspiration accelerates venous return, increasing
the right atrial and right ventricular filling. This causes
the interventricular septum to bulge to the left. This
bulging of the interventricular septum into the left
ventricle during inspiration is referred to as the ‘reversed’
Bernheim effect. This effect contributes to the reduction
in left ventricular stroke volume during inspiration. This
decreased left ventricular stroke volume is responsible for
the normal slight fall in blood pressure during inspiration
(an exaggerated fall is called as pulsus paradoxus).
6. How will you clinically differentiate jugular venous
pulsations from carotid pulsation?
The clinical differences between jugular venous pulsations
and carotid pulsation in the neck are the following (Table 2):