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place signs, as along a road; "sign an intersection"; "This road has been signed"
(medicine) any objective evidence of the presence of a disorder or disease; "there were no signs of asphyxiation"
a perceptible indication of something not immediately apparent (as a visible clue that something has happened); "he showed signs of strain"; "they welcomed the signs of spring" (同)mark
a character indicating a relation between quantities; "dont forget the minus sign"
a fundamental linguistic unit linking a signifier to that which is signified; "The bond between the signifier and the signified is arbitrary"--de Saussure
a gesture that is part of a sign language
a public display of a message; "he posted signs in all the shop windows"
engage by written agreement; "They signed two new pitchers for the next season" (同)contract, sign on, sign_up
approve and express assent, responsibility, or obligation; "All parties ratified the peace treaty"; "Have you signed your contract yet?" (同)ratify
communicate silently and non-verbally by signals or signs; "He signed his disapproval with a dismissive hand gesture"; "The diner signaled the waiters to bring the menu" (同)signal, signalize, signalise
mark with ones signature; write ones name (on); "She signed the letter and sent it off"; "Please sign here" (同)subscribe
be engaged by a written agreement; "He signed to play the casino on Dec. 18"; "The soprano signed to sing the new opera"
communicate in sign language; "I dont know how to sign, so I could not communicate with my deaf cousin"
having a handwritten signature; "a signed letter"

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(ある事実・状態・感情などの)『表れ』,印,気配,徴侯(indication);(…の)こん跡,計跡《+『of』+『名』》・『身ぶり』,手まね,合図 / 『標識』,看板 / (数学・音楽などの)記号 / (…の)『象徴』,シンボル(symbol)《+『of』+『名』》・《文》(…の)『前兆』,きざし《+『of』+『名』》・宮(きゅう)(黄道12区分の一つ) ・〈手紙・書類・作品など〉‘に'『署名する』・(…に)〈名前など〉‘を'書く《+『名』+『on』(『to』)+『名』》 / …‘を'雇う契約に署名する・…‘を'合図する,知らせる;…に合図する・署名する・契約書に署名して雇われる
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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/08/04 03:34:24」(JST)

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Not to be confused with Kussmaul breathing.

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.

Pathophysiology[edit source | edit]

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.

Causes[edit source | edit]

The differential diagnosis generally associated with Kussmaul's sign is constrictive pericarditis, along with restrictive cardiomyopathy and cardiac tamponade.^[1]

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.^[2]

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

History[edit source | edit]

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.

References[edit source | edit]

^ "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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UpToDate Contents

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1. 頚静脈波の検討 examination of the jugular venous pulse
2. 収縮性心膜炎 constrictive pericarditis
3. 心タンポナーデ cardiac tamponade
4. 収縮性心膜炎と拘束性心筋症の区別 differentiating constrictive pericarditis and restrictive cardiomyopathy
5. うっ血肝 congestive hepatopathy

English Journal

Pulsus paradoxus; historical and clinical perspectives.

Abu-Hilal MA, Mookadam F.SourceDepartment of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. abuhilal.mohannad@yahoo.com
International journal of cardiology.Int J Cardiol.2010 Feb 4;138(3):229-32. Epub 2009 May 22.
Pulsus paradoxus or the paradoxical pulse is an exaggeration of the normal inspiratory decrease in systolic blood pressure. The current definition of pulsus paradoxus is an inspiratory drop in systolic blood pressure>10 mm Hg. This physical sign can occur in conditions like cardiac tamponade, con
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[Superior vena cava syndrome by cardiac tumor].

Brueck M, Bandorski D, Stahl U, Kramer W.SourceMedizinische Klinik I, Klinikum Wetzlar, Akademisches Lehrkrankenhaus der Universitat Giessen, Wetzlar, Germany. Martin.Brueck@hkw.med.uni-giessen.de
Medizinische Klinik (Munich, Germany : 1983).Med Klin (Munich).2009 Jan 15;104(1):52-7. Epub 2009 Jan 14.
CASE REPORT: A 59-year-old man with a 4-week history of dyspnea, coughing, and chest discomfort was referred to hospital for further evaluation. Moreover, he reported fever and fatigue. There were neither cardiovascular risk factors nor drug medication. 6 months earlier, a deep vein thrombosis of hi
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