Kussmaul's sign and rapid X-Y descents in constrictive pericarditis.

Right-sided heart failure is not uncommon. A careful jugular venous examination looking for the distinct Kussmaul's sign and rapid X-Y descents, which are highly indicative of constrictive pericarditis, is markedly helpful in guiding the correct diagnosis and proper management.

Manuscript

A 60‐year‐old woman complained of progressive dyspnea for 2 years. On examination, paradoxical jugular veins distension during inspiration, known as Kussmaul's sign, and excessive brisk descents of jugular pressure, known as rapid X‐Y descents, were observed (Video S1). Heart sounds were normal. Chest X‐ray showed marked calcification of the pericardium. Hemodynamics study from echocardiography and cardiac catheterization confirmed the diagnosis of constrictive pericarditis, in which the elevation and equalization of diastolic filling pressure in all chambers [mean right atrial (RA) pressure, mean pulmonary artery (PA) wedge pressure, right ventricular (RV) end‐diastolic pressure, and left ventricular (LV) end‐diastolic pressure of 28, 29, 30, and 32 mmHg, respectively], prominent X‐Y descents in RA pressure trace, diastolic dip‐and‐plateau pattern in LV and RV pressure traces, and ventricular interdependence were revealed from the latter study.

Common causes of constrictive pericarditis include tuberculosis, bacterial infection, viral infection, radiation, postcardiac surgery, and idiopathic condition. On a thorough evaluation, however, the obvious cause of pericarditis in our patient was inconclusive; hence, leading to the diagnosis of idiopathic constrictive pericarditis. The Kussmaul's sign and rapid X‐Y descents, which resulted from RV filling impairment, are the hallmark clinical presentations of constrictive pericarditis.1 Nevertheless, they could also be found in restrictive cardiomyopathy and RV failure 1.

The pericardiectomy, which resulted in an improvement of her symptoms, was performed two years later due to she initially denied surgery.

Conflict of Interest

None declared.

VideoS1. The video of this process is found in the online version of this article.

Click here for additional data file.