Kussmaul's sign is a paradoxical rise in jugular venous pressure (JVP) on inspiration, or a failure in the appropriate fall of the JVP with inspiration.
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 sign suggests impaired filling of the right ventricle due to 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 distention (JVD) and is seen clinically in the internal jugular veins becoming more readily visible.
[citation needed] The differential diagnoses of Kussmaul's sign includes constrictive pericarditis, restrictive cardiomyopathy, pericardial effusion, and severe right-sided heart failure.