here for the video
In healthy individuals, breathing in (inspiring)
increases venous return to the right heart. Any evident
neck vein distension, therefore, should diminish during
In patients with conditions that impair venous return to
the right heart inspiration may be associated with an
absence of jugular vein collapse or a paradoxical rise in
the jugular column (video). This is called Kussmaul's
Cardiac conditions that may be associated
with a positive Kussmaul's sign include right atrial myxoma,
tricuspid stenosis, constrictive pericarditis, pericardial
effusion, restrictive myocardopathy, and severe pulmonary
hypertension. Overall, the commonest cause is severe
right-sided congestive heart failure.
Superior vena cava obstruction can also
result in a positive Kussmaul's sign.