Kussmaul's sign is classically described in

Ref Harrison 19 th ed pg 1576 The patient often appears chron- ically ill, and in advanced cases, anasarca, skeletal muscle wasting, and cachexia may be present. Exeional dyspnea is common, and ohop- nea may occur, although it is usually not severe. Acute left ventricular failure (acute pulmonary edema) is very uncommon. The cervical veins are distended and may remain so even after intensive diuretic treatment, and venous pressure may fail to decline during inspiration (Kussmaul's sign). The latter is common in chronic pericarditis but may also occur in tricuspid stenosis, right ventricular infarction, and restrictive cardiomyopathy.