Pulsus Paradoxus

Aka: Pulsus Paradoxus, Paradoxical Pulse

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II. Definition

  1. Inspiratory decrease in arterial pressure >10 mm Hg
  2. Inspiratory venous pressure unchanged (Kussmaul's Sign)

III. Causes

  1. Pericardial Effusion
  2. Adhesive Pericarditis
  3. Cardiac Tamponade
  4. Pulmonary Emphysema
  5. Severe Asthma
  6. Para-mediastinal effusion
  7. Endocardial fibrosis
  8. Myocardial Amyloidosis
  9. Scleroderma
  10. Mitral Stenosis with Right Heart Failure
  11. Tricuspid stenosis
  12. Hypovolemia
  13. Pulmonary Embolism

IV. Signs

  1. Palpable decrease in pulse with inspiration
  2. Inspiratory systolic Blood Pressure decreased
    1. Over 10 mm Hg less than expiratory pressure

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