not be confused with the exaggeration of the normal expiratory increase in venous pressure that is often
seen in patients with pulmonary disease. Instead, Kussmaul’s sign reflects some sort of obstruction to
right-sided venous return, like superior vena cava syndrome, tricuspid stenosis, right ventricular hypertrophy or infarction, constrictive pericarditis, pulmonary emboli, and severe pulmonary hypertension. Of interest, patients with tamponade do not demonstrate Kussmaul’s sign; yet, they do demonstrate pulsus paradoxus. Conversely, “pulsus” (albeit one that is never >21 mmHg) may occur in some patients with Kussmaul’s.