Kussmaul Physiology in Patients With Heart Failure

Elevated right atrial (RA) pressure is associated with renal impairment and increased mortality in patients with heart failure. Raised jugular venous pressure, as a bedside estimate of RA pressure, has similarly been shown to be associated with adverse outcome with increased heart failure hospitalizations and death. RA pressure (and jugular venous pressure) normally falls during inspiration despite an increase in pulmonary vascular resistance and venous return, as the right ventricle (RV) normally accommodates the increase in preload and increase pulmonary arterial flow. A paradoxical increase in jugular venous pressure was described by Adolf Kussmaul in 1873, and this is now an eponymous clinical sign that bears his name. Although widely reported as a clinical sign of constrictive pericarditis, Kussmaul sign has also been described in patients with heart failure.