Kussmaul's sign

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Kussmaul's sign
Specialty Cardiology

Kussmaul's sign is a paradoxical rise in jugular venous pressure (JVP) on inspiration, or a failure in the appropriate fall of the JVP with inspiration. It can be seen in some forms of heart disease and is usually indicative of limited right ventricular filling due to right heart dysfunction.

Contents

Pathophysiology

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 sign suggests impaired filling of the right ventricle due to 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 distention (JVD) and is seen clinically in the internal jugular veins becoming more readily visible.[ citation needed ]

Causes

The differential diagnoses of Kussmaul's sign includes constrictive pericarditis, restrictive cardiomyopathy, pericardial effusion, and severe right-sided heart failure.[ citation needed ]

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. [1]

Other possible causes of Kussmaul's sign include:[ citation needed ]

History

Kussmaul's sign is named after the German doctor who first described it, Adolph Kussmaul (1822-1902). [3] [4] He is also credited with describing Kussmaul breathing. [5]

See also

Related Research Articles

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<span class="mw-page-title-main">Heart failure with preserved ejection fraction</span> Medical condition

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<span class="mw-page-title-main">Ischemic cardiomyopathy</span> Medical condition

Ischemic cardiomyopathy is a type of cardiomyopathy caused by a narrowing of the coronary arteries which supply blood to the heart. Typically, patients with ischemic cardiomyopathy have a history of acute myocardial infarction, however, it may occur in patients with coronary artery disease, but without a past history of acute myocardial infarction. This cardiomyopathy is one of the leading causes of sudden cardiac death. The adjective ischemic means characteristic of, or accompanied by, ischemia — local anemia due to mechanical obstruction of the blood supply.

References

  1. Disorders of the Cardiovascular System; Harrison's Principles of Internal Medicine 17th, and Self-assessment & Board Review cardiovascular system questions 15, 29
  2. Meyer, Theo E.; Sareli, Pinhas; Marcus, Richard H.; Pocock, Wendy; Berk, Martin R.; McGregor, Maurice (1989). "Mechanism underlying Kussmaul's sign in chronic constrictive pericarditis". The American Journal of Cardiology. 64 (16): 1069–1072. doi:10.1016/0002-9149(89)90817-5. ISSN   0002-9149. PMID   2816746.
  3. synd/1368 at Who Named It?
  4. A. Kussmaul. Über schwielige Mediastino-Perikarditis und den paradoxen Puls. Berliner klinische Wochenschrift, 1873, 10: 433-435, 445-449 and 461-464.
  5. Kussmaul's respiration at Who Named It?