Kussmaul’s Sign | NEJM

A 55-year-old woman with a history of Hodgkin’s lymphoma treated with mantle field radiation had subacute, progressive dyspnea on exertion. Distention of the jugular veins and elevation of jugular venous pressure during inspiration, known as Kussmaul’s sign, were observed. Causes of Kussmaul’s sign include right ventricular infarction, severe right ventricular failure, restrictive cardiomyopathy, constrictive pericarditis, and tricuspid stenosis. It was postulated that this patient had constrictive pericarditis related to mediastinal radiation therapy, leading to impaired filling of the heart and giving rise to Kussmaul’s sign. See this Image in Clinical Medicine at :