Kussmaul's sign is NOT seen in: March 2011

Ans. D: Cardiac tamponade A positive Kussmaul sign is rare in cardiac tamponade Davidson's (21st ed., p-542) includes Kussmaul's sign as a clinical feature of pericardial/ cardiac tamponade Normal physiology: Ordinarily the JVP falls with inspiration due to reduced pressure in the expanding thoracic cavity. 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 distension. Causes of Kussmaul's sign: The differential diagnosis generally associated with Kussmaul's sign is constrictive pericarditis, 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 Right ventricular infarction - low ventricular compliance Right hea failure Cardiac tumours Tricuspid stenosis