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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. It can be seen in some forms of heart disease and is usually indicative of limited right ventricular filling due to right heart dysfunction.
The patient is positioned at a 45° incline, and the filling level of the external jugular vein determined. [1] The internal jugular vein is visualised when looking for the pulsation. In healthy people, the filling level of the jugular vein should be less than 4 centimetres vertical height above the sternal angle. [2]
Beck's triad is a collection of three medical signs associated with acute cardiac tamponade, a medical emergency when excessive fluid accumulates in the pericardial sac around the heart and impairs its ability to pump blood. The signs are low arterial blood pressure, distended neck veins, and distant, muffled heart sounds. [1]
The clinician presses firmly over either the right upper quadrant of the abdomen (i.e., over the liver) or over the center of the abdomen [2] for 10 seconds with a pressure of 20 to 35 mm Hg while observing the swelling of the internal jugular vein in the neck and also observing to be sure the patient does not perform a Valsalva maneuver.
A man with congestive heart failure and marked jugular venous distension. External jugular vein marked by an arrow. Pitting edema during and after the application of pressure to the skin. A jugular venous distension is the most sensitive clinical sign for acute decompensation. [7]
In TACO, the patient will always have a positive fluid balance and will often present with hypertension, jugular venous distension, elevated BNP, peripheral edema, and will respond well to diuretics. In contrast, TRALI is not associated with fluid overload and the patient may have a positive, even, or net fluid balance.
Diagnosis may be suspected based on low blood pressure, jugular venous distension, or quiet heart sounds (together known as Beck's triad). [2] [1] [7] A pericardial rub may be present in cases due to inflammation. [2] The diagnosis may be further supported by specific electrocardiogram (ECG) changes, chest X-ray, or an ultrasound of the heart. [2]
Patients are seen with a cyanotic discoloration of the shoulder skin and neck and face, jugular distention, bulging of the eyeballs, and swelling of the tongue and lips. The latter two are resultants of edema, caused by excessive blood accumulating in the veins of the head and neck and venous stasis.
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