Kussmaul sign is seen in which condition?

• A. Pericarditis
• B. Right-sided heart failure
• C. Left-sided heart failure
• D. Pulmonary embolism

Answer: (B)

Kussmaul sign is a paradoxical rise in the jugular venous pressure during inspiration, reflecting impaired filling of the right ventricle. Normally inspiration lowers intrathoracic pressure and helps venous return; when the right ventricle can’t accommodate that increased return—because of right-sided heart disease, such as right ventricular failure—the JVP climbs instead of falling. This makes right-sided heart failure the best match among the options. Left-sided failure primarily causes pulmonary edema and does not produce this inspiratory rise in JVP. While constrictive pericarditis or restrictive cardiomyopathy can show Kussmaul sign, the scenario here points to right-sided involvement. Pulmonary embolism can cause acute RV strain but is not a classic, defining cause of Kussmaul sign.