Kussmaul’s Sign

Kussmaul’s sign is defined as a paradoxical rise in jugular venous pressure during inspiration. Decreased intrathoracic pressure during inspiration normally leads to an increase in venous return to the right side of the heart, with an associated decrease in jugular venous pressure. When there is impaired filling of the right ventricle, the jugular veins instead become engorged. Causes of Kussmaul’s sign include right ventricular infarction, severe right ventricular failure, restrictive cardiomyopathy, constrictive pericarditis, and tricuspid stenosis.

Card Tutorial

Patient 2

This patient developed constrictive pericarditis many years after orthotopic heart transplantation, a rare sequala of that procedure. The astute observer will also note that in addition to Kussmaul’s sign, these videos demonstrate the presence of the W sign in the jugular venous waveform.

Video courtesy of BMJ case reports: “Jugular venous pulse in constrictive pericarditis”

Kussmaul’s Sign

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