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.
Patient 1:
This patient developed constrictive pericarditis many years after external beam radiation therapy to the chest. The video demonstrates the defining feature of Kussmaul’s sign, a paradoxical rise in jugular venous pressure with inspiration.
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
Annotated
Patient 3:
This patient was admitted to the hospital with decompensated heart failure related to severe pulmonary hypertension from systemic sclerosis. Note the paradoxical rise in jugular venous pressure with inspiration.
Patient 4:
This patient was admitted to the hospital after suffering a myocardial infarction. He was noted to have Kussmaul’s sign on examination, of unclear etiology. His medical history was notable only for Hodgkin’s lymphoma when he was a teenager, treated with mediastinal radiation. Note the tattoo marker on the chest.
Kussmaul’s Sign
Annotated
Patient 5:
This is an older man who was admitted to the hospital with chronic progressive dyspnea and was found to have severe pulmonary hypertension from chronic thromboembolic disease.
This patient also has a right ventricular heave.
Patient 6:
This patient has Kussmaul’s sign.
Patient 7:
This is an older man who was admitted with sudden-onset dyspnea and was given a diagnosis of pneumonia. He was found to have elevated JVP with Kussmaul’s sign, leading to a new diagnosis of heart failure secondary to acute coronary syndrome.
Patient 8:
This patient has Kussmaul’s sign and Frank’s sign.
Patient 9:
Patient 10:
This patient has severe Aortic Stenosis and Kussmaul’s sign.
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.