This sign is used as an adjunct while investigating the jugular venous pressure.


  1. The sign is positive when there is a paradoxical rise in JVP or absence of JVP depression during inspiration
  2. Normally, when inspecting the JVP, it declines during inspiration but the amplitude of the A wave increases.
  3. A positive kussmaul's sign suggests impaired venous return to the right heart
  4. A positive sign is most commonly associated with right-sided congestive heart failure, but can also be caused by superior vena cava obstruction
  5. A positive sign may also be an indication of severe right-sided heart failure, constrictive pericarditis, myocardial restrictive disease, SVC syndrome or tricuspid stenosis


  1. Chatterjee K. Examination of the Jugular Venous Pulse. September 2010. Uptodate Online 18.3. Accessed January 3rd 2011 from