Kussmaul's Sign on Physical Exam Kussmaul sign is a paradoxical rise in jugular venous pressure (JVP) on inspiration, or a failure in the appropriate fall of the JVP with inspiration. Normally, venous pressure should drop at least 3 mmHg with inspiration. The Kussmaul sign is defined by an increase (or lack of fall) of jugular venous pressure with inspiration and is classically associated with constrictive pericarditis, although it has been reported in patients with restrictive cardiomyopathy, m

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