Kussmaul's sign
Encyclopedia
Kussmaul's sign is the observation of a rise in jugular venous pressure
(JVP, the filling of the jugular vein
) on inspiration. It can be seen in some forms of heart disease
and is usually indicative of limited right ventricular filling.
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 distension.
, along with restrictive cardiomyopathy
and cardiac tamponade
.
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, see Beck's triad.
Other possible causes of Kussmaul's sign include:
doctor who first described it, Adolph Kussmaul
(1822-1902). He is also credited with describing Kussmaul breathing
.
Jugular venous pressure
The jugular venous pressure is the indirectly observed pressure over the venous system...
(JVP, the filling of the jugular vein
Jugular vein
The jugular veins are veins that bring deoxygenated blood from the head back to the heart via the superior vena cava.-Internal and external:There are two sets of jugular veins: external and internal....
) on inspiration. It can be seen in some forms of heart disease
Cardiology
Cardiology is a medical specialty dealing with disorders of the heart . The field includes diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology...
and is usually indicative of limited right ventricular filling.
Background
Ordinarily the JVP falls with inspiration due to reduced pressure in the expanding thoracic cavity. Kussmaul's sign suggests impaired filling of the right ventricleRight ventricle
The right ventricle is one of four chambers in the human heart. It receives deoxygenated blood from the right atrium via the tricuspid valve, and pumps it into the pulmonary artery via the pulmonary valve and pulmonary trunk....
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 distension.
Causes
The differential diagnosis generally associated with Kussmaul's sign is constrictive pericarditisConstrictive pericarditis
In many cases, constrictive pericarditis is a late sequela, in other words a condition that is the consequence of a previous disease, of an inflammatory condition of the pericardium...
, along with restrictive cardiomyopathy
Restrictive cardiomyopathy
Restrictive cardiomyopathy is a form of cardiomyopathy in which the walls are rigid, and the heart is restricted from stretching and filling with blood properly....
and cardiac tamponade
Cardiac tamponade
Cardiac tamponade, also known as pericardial tamponade, is an emergency condition in which fluid accumulates in the pericardium ....
.
With cardiac tamponade
Cardiac tamponade
Cardiac tamponade, also known as pericardial tamponade, is an emergency condition in which fluid accumulates in the pericardium ....
, jugular veins are distended and typically show a prominent x descent and an absent y descent as opposed to patients with constrictive pericarditis, see Beck's triad.
Other possible causes of Kussmaul's sign include:
- Right ventricular infarction - low ventricular compliance
- Right heart failure
- Cardiac tumours
- Tricuspid stenosis
History
Kussmaul's sign is named after the GermanGermany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
doctor who first described it, Adolph Kussmaul
Adolph Kussmaul
Adolph Kussmaul was a German physician and a leading clinician of his time. He was born as the son and grandson of physicians at Graben near Karlsruhe and studied at Heidelberg. He entered the army after graduation and spent two years as an army surgeon...
(1822-1902). He is also credited with describing Kussmaul breathing
Kussmaul breathing
Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis but also renal failure. It is a form of hyperventilation, which is any breathing pattern that reduces carbon dioxide in the blood due to increased rate or...
.