Pulsus Paradoxus – MD Nexus

Definition

Pulsus Paradoxus: decreased systolic blood pressure with inspiration
- Observed in Arterial Line Waveform (see Arterial Line)

Cardiogenic Shock (see Cardiogenic Shock)
Constrictive Pericarditis (see Constrictive Pericarditis)
- Epidemiology: pulsus paradoxus is less common in constrictive pericarditis
Hypovolemia (see Hypovolemic Shock)
- Epidemiology: in sepsis
- Respiratory Pulse Pressure Variation, Delta PP ((Max-Min Pulse Pressure)/Average Pulse Pressure), Predicts Cardiac Output Response to an Intravenous Fluid Challenge Better than CVP and PCWP (Am J Resp Crit Care Med, 2000) [MEDLINE]
Tamponade/Pericardial Effusion (see Tamponade and Pericardial Effusion)
- Epidemiology: pulsus paradoxus is commonly observed in the setting of tamponade
- Physiology: pulsus paradoxus is observed during spontaneous breathing
- Diagnosis
  - Echocardiogram
    - Diastolic RV and LV Collapse
    - Systolic RA and LA Collapse
    - Increased Variability in Mitral (>25%) Inflow Velocity
    - Increased Variability in Tricuspid (>40%) Inflow Velocity

Acute Pulmonary Embolism (PE) (see Acute Pulmonary Embolism)
- Physiology: RV outflow obstruction
Asthma (see Asthma)
- Epidemiology: pulsus paradoxus is common in asthma
- Physiology:
Chronic Obstructive Pulmonary Disease (COPD) (see Chronic Obstructive Pulmonary Disease, [[Chronic Obstructive Pulmonary Disease]])
- Physiology:
Tension Pneumothorax (see Pneumothorax)

Abdominal Compartment Syndrome (see Abdominal Compartment Syndrome)
- Physiology: due to transmission of high intra-abdominal pressures to thorax -> impaired right-sided venous return
Anaphylaxis (see Anaphylaxis)
Superior Vena Cava (SVC) Syndrome (see Superior Vena Cava Syndrome)
- Physiology: RV inflow obstruction

Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med. 2000 Jul;162(1):134-8 [MEDLINE]
Focused critical care echocardiography. Crit Care Med. 2013;41:2618–2626 [MEDLINE]
Advanced echocardiography for the critical care physician: Part 1. Chest. 2014;145:129–134 [MEDLINE]
Advanced echocardiography for the critical care physician: Part 2. Chest. 2014;145:135–142 [MEDLINE]