Kussmaul's sign

A paradoxical inspiratory rise or failure of the normal inspiratory decline in jugular venous pressure, reflecting impaired right ventricular diastolic filling and abnormal transmission of intrathoracic pressure changes to the right heart.

Causes

• Pericardial and myocardial causes

  • Constrictive pericarditis

  • Restrictive cardiomyopathy

  • Severe right-sided heart failure

  • Right ventricular infarction

  • Cardiac tamponade (occasionally associated)

• Right ventricular pressure overload

  • Tricuspid stenosis

  • Massive pulmonary embolism

• Pulmonary causes

  • Pulmonary hypertension with severe right ventricular dysfunction

  • Advanced right ventricular failure due to chronic lung disease (cor pulmonale)