Frog sign

Synonyms

Pounding in the neck;

Definition

Frog sign refers to so-called bilateral (Krinock 2021) grafting of the jugular veins (pulsatile protrusion of the jugular veins [Ashraf 2020]) that occurs with simultaneous contraction of the atria and ventricles (Herold 2022).

The frog sign is seminal for AV nodal reentry tachycardia (Trappe 2009). It can also occur in "circus movement tachycardia" with accessory pathways (Marx 2015).

Once the ventricle and atria are activated simultaneously, a so-called frog sign may occur (Goeminne 2013), as atrial contraction against closed AV valves (Kasper 2015) results in backflow of blood into the superior vena cava and jugular veins (Ho 2022).

Diagnosis of a frog sign is based on physical examination of the neck (Krinock 2021), which reveals rapid and regular pulsations with bulges of the internal jugular veins (Velibey 2018).

Echocardiographically, a huge flow wave, the so-called "a" wave, can be seen when the atria contract against the closed AV- valves (Krinock 2021).

Therapy consists of treatment of AV nodal reentry tachycardia (Krinock 2021) s. d.

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