Q) Kussmaul sign is not seen in

a) Restrictive Cardiomyopathy

b) Pulmonary embolism

c) Constrictive pericarditis

d) Severe right ventricular infarction

Answer b

Kussmaul sign is seen in massive pulmonary embolism only.

It is the abnormal variation in jugular venous pressure during inspiration. Normally during inspiration the mean venous pressure decreases and the amplitude of a wave increases. 

In Kussmaul sign, the jugular venous pressure increases or remains the same. This is seen in number of  conditions.

Constrictive or effusive pericarditis

Restrictive cardiomyopathy.

Predominant right ventricular infarction

Severe right ventricular dysfunction

Massive pulmonary embolism.

Partial obstruction of the vena cavae.

Right atrial and right ventricular tumors.

Severe tricuspid regurgitation

Occasionally tricuspid stenosis and congestive heart failure.

Rarely cardiac tamponade

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