Kussmaul's sign is a paradoxical rise in jugular venous pressure (JVP) on inspiration. It can be seen in some forms of heart disease and is usually indicative of limited right ventricular filling due to right heart failure.
Ordinarily the JVP falls with inspiration due to reduced pressure in the expanding thoracic cavity and the increased volume afforded to right ventricular expansion during diastole. Kussmaul's sign suggests impaired filling of the right ventricle due to either fluid in the pericardial space or a poorly compliant myocardium or pericardium. This 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 external jugular veins becoming more readily visible.
With cardiac tamponade, jugular veins are distended and typically show a prominent x descent and an absent y descent as opposed to patients with constrictive pericarditis (prominent x and y descent), see Beck's triad.
It is present in constrictive pericarditis and rare in tamponade, but absent in restrictive cardiomyopathy and right ventricular MI.
Other possible causes of Kussmaul's sign include:
- Right ventricular infarction - low ventricular compliance
- Right heart failure
- Cardiac tumours
- Tricuspid stenosis
- "Kussmaul's Sign". General Practice Notebook - a UK medical reference.
- Disorders of the Cardiovascular System; Harrison's Principles of Internal Medicine 17th, and Self-assessment & Board Review cardiovescular system questions 15, 29
- synd/1368 at Who Named It?
- A. Kussmaul. Über schwielige Mediastino-Perikarditis und den paradoxen Puls. Berliner klinische Wochenschrift, 1873, 10: 433-435, 445-449 and 461-464.
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