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this is a true story i was paid shortly after arriving to the hospital to evaluate a patient who had been admitted overnight for an initial encounter of reported heart failure with preserved ejection fraction and the diagnosis was not unwarranted he had arrived to kipnick with an elevated bmp and he was being actively diuresed a de-dimer in the emergency department was negative and an ekg showed only mild sinus tachycardia and he was a guy who didnt doctor much and so nothing else was known about him on physical exam not only did he have distended internal jugular veins up to nearly his earlobe but it actually increased in distension on inhalation so this was koosmals side by the end of this video you should be able to define course male sign recite several diseases that could lead to a positive cousin sign and explain its pathophysiology before we explain what leads to co-small sign lets review basic intrathoracic pressure so when you breathe in does interthoracic pressure go down
