Friedreich's sign

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Friedreich's sign
Differential diagnosisConstrictive pericarditis

Friedreich's sign is the exaggerated drop in the jugular venous pressure (JVP) in diastole, seen in constrictive pericarditis.[1] It is manifested as abrupt collapse of the neck veins or marked descent of the central venous pressure waveform.[2]

The normal jugular venous waveform contains two descents, x and y. The x descent, which corresponds to the combination of right atrial relaxation and depression of the atrial floor during ventricular contraction, is normally dominant. The y descent occurs as a result of passive ventricular filling during early diastole and is usually absent in patients with tamponade. In constrictive pericarditis, the characteristic sharp and deep y descent reflects rapid filling in early diastole which occurs when the unyielding pericardium elevates atrial pressure and limits ventricular filling to the early diastolic period. Friedreich’s diastolic collapse of the cervical veins, describes a sharp and deep y descent of the jugular venous waveform. It can be a clue to the diagnosis of constrictive pericarditis.[citation needed]

The sign is named after Nikolaus Friedreich.[3] It was formally referred to as Friedreich’s diastolic collapse of the cervical veins.[2]


  1. Camm, Christian Fielder; Camm, A. John (2016). "1. Examination techniques". Clinical Guide to Cardiology. Chichester: Wiley Blackwell. p. 10. ISBN 978-1-118-75533-4. Archived from the original on 2023-06-30. Retrieved 2023-05-28.
  2. 2.0 2.1 Pittenger, Brook; Sullivan, Peter D.; Mansoor, André Martin (16 October 2018). "Friedreich's sign". BMJ case reports. 2018: bcr–2018–226820. doi:10.1136/bcr-2018-226820. ISSN 1757-790X. PMID 30333203. Archived from the original on 9 July 2022. Retrieved 8 November 2022.
  3. Harris, Peter; Nagy, Sue; Vardaxis, Nicholas (2018). Mosby's Dictionary of Medicine, Nursing and Health Professions (3rd ed.). Elsevier. p. 709. ISBN 978-0-7295-8691-7. Archived from the original on 2022-11-12. Retrieved 2022-11-08.