Kussmaul's sign in Constrictive Pericarditis 



A 50-year-old woman with a remote history of mediastinal lymphoma (age 20) develops SOB. You notice several circular blue marks on her chest (photo). And you evaluate her JVP (video). There is an extra heart sound after S2. What is the underlying diagnosis and why? 



Kussmaul's sign is the paradoxical rise in JVP with inspiration. Causes = RV failure, restrictive CM, constrictive pericarditis (this case), and tricuspid stenosis. The extra sound is a pericardial knock. The rapid Y descent is known as Friedreich’s sign



Dr. André Mansoor @AndreMansoor - Author of Frameworks for Internal Medicine https://amzn.to/2LmUODZ



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