Pulsus paradoxus and Kussmaul's sign in acute pulmonary embolism

Abstract

Angiographically proved pulmonary embolic disease was associated with abnormal venous or arterial pressure responses, or both, to inspiration in three patients. The abnormal responses were evident clinically as paradoxical inspiratory filling of the cervical veins (Kussmaul's sign) or an exaggerated decrease in systemic blood pressure during inspiration (pulsus paradoxus). The hemodynamic abnormalities documented at the time of cardiac catheterization occurred in the setting of multiple acute pulmonary emboli, pulmonary hypertension and underlying cardiac disease. Pulmonary embolism should be considered in the differential diagnosis of pulsus paradoxus and Kussmaul's sign.