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 11

This is a middle-aged man with drug-induced cardiomyopathy, admitted to the hospital with decompensated heart failure. This patient also has a S4 gallop.