Kussmaul’s sign

Kussmaul’s sign is a paradoxical rise in jugular venous pressure (JVP) on inspiration, or a failure in the appropriate fall of the JVP with inspiration.


It is seen in some forms of heart disease and is usually indicative of limited right ventricular filling due to right heart dysfunction.

Jugular venous pressure falls with inspiration due to reduced pressure in the expanding thoracic cavity and the increased volume afforded to right ventricular expansion during diastole. 


Kussmaul sign suggests impaired filling of the right ventricle due to a poorly compliant myocardium or pericardium. 


The impaired filling causes the increased blood flow to back up into the venous system, causing the jugular vein distension (JVD) and is seen clinically in the internal jugular veins becoming more readily visible.


Differential diagnoses of Kussmaul’s sign: constrictive pericarditis, restrictive cardiomyopathy, pericardial effusion, and severe right-sided heart failure.


With cardiac tamponade, distended jugular veins typically show a prominent x descent and an absent y descent as opposed to patients with constrictive pericarditis with prominent x and y descent.


Other possible causes of Kussmaul’s sign include:

Right ventricular infarction 

Right heart failure

Cardiac tumors

Tricuspid stenosis

Restrictive cardiomyopathy

Pulmonary embolism

Constrictive pericarditis

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