Ans. is 'c' i.e., Associated with decreased afterload [Ref: CMDT 2007p. 318; British Medical Journal May 1999 Hepatojugular refluxThis is done by applying firm pressure with the palm of the hand to the right upper quadrant of the abdomen for 10- 30 seconds with the patients breathing quietly while the jugular vein is observed.In normal subjects (Negative hepatojugular reflux)Jugular venous pressure rises only transiently with rapid return to the baseline.Positive hepatojugular reflux (Left ventricular failure Q)A positive abdominojugular reflux sign is defined by an increase in the jugular venous pressure of greater than 3 cm, sustained for greater than 15 seconds.ExplanationPushing on the liver (or even midabdomen) for about 15 seconds increases the amount of blood returned to the right atrium and right ventricle (increased preload).Concurrently, there is increase in right ventricle afterload, owing to upward movement of the diaphragm which reduces intrathoracic volumes. (Pulmonary artery pressure is increased due to reduced intrathoracic volumes). (Leading to increased right ventricle afterload)In a normal person the jugular venous pressure would rise temporarily and then normalize quickly as the healthy right ventricle pumps out the additional blood i.e. it handles the increase in preload and afterload quite well.A dysfunctioning right ventricle however fails to accept this increase in preload and afterload and therefore there is persistent elevation of systemic venous pressure.The abdominojugular reflux is not specific to any disorder but rather is a reflection of the inability of the right ventricle to accept or reject the transiently increased venous return."Positive abdominojugular reflux is most commonly associated with left ventricular failure".In the absence of left heart failure a positive abdominal jugular reflex sign should prompt consideration of :-Impaired right ventricular preloadA Decrease in right ventricular compliance.A decrease in right ventricular systolic function orAn elevation in right ventricular afterload.Conditions associated with abdominojugular reflux -Left ventricular failure Q (MC)Right heart failure QConstrictive pericarditis QRight ventricular infarction QRestrictive cardiomyopathy QNote - Both pulmonary stenosis and tricuspid regurgitation cause right heart failure.