Diagnostic Signs in Compressive Cardiac Disorders

THE COMBINATION of two physical signs, increasing venous pressure and palpable decrease in arterial systolic and pulse pressure with inspiration in constrictive pericarditis was pointed out by Kussmaul.1 Wood2 alluded to these signs as evidence for pericardial effusion and attributed the rise in venous pressure to an inspiratory rise in intrapericardial pressure. Dock3 subscribed to this view, supporting his hypothesis by studies in cadavers. A recent monograph by Spodick,4 treating compressive cardiac disease and encompassing chronic constrictive pericarditis and pericardial effusion, reported that Kussmaul's venous sign is present in pericardial effusion. In contrast, Hitzig5 examined the venous pressure in constrictive pericarditis, right heart failure, and a small number of patients with pericardial effusion and tamponade. Kussmaul's venous and arterial signs were present in 25% of the patients with constrictive pericarditis; however, both constrictive pericarditis and congestive heart failure were associated with a rise in directly recorded venous pressure at the end of deep inspiration. Kussmaul's venous sign was absent in peri-