Pulsus Paradoxus
Definition
Pulsus Paradoxus : decreased systolic blood pressure with inspiration
Observed in Arterial Line Waveform (see Arterial Line , [[Arterial Line]])
Etiology
Cardiac
Cardiogenic Shock (see Cardiogenic Shock , [[Cardiogenic Shock]])
Constrictive Pericarditis (see Constrictive Pericarditis , [[Constrictive Pericarditis]])
Epidemiology : pulsus paradoxus is less common in constrictive pericarditis
Hypovolemia (see Hypovolemic Shock , [[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 , [[Tamponade]] and Pericardial Effusion , [[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
Pulmonary
Acute Pulmonary Embolism (PE) (see Acute Pulmonary Embolism , [[Acute Pulmonary Embolism]])
Physiology : RV outflow obstruction
Asthma (see Asthma , [[Asthma]])
Epidemiology : pulsus paradoxus is common in asthma
Physiology :
Chronic Obstructive Pulmonary Disease (COPD) (see Chronic Obstructive Pulmonary Disease , [[Chronic Obstructive Pulmonary Disease]])
Tension Pneumothorax (see Pneumothorax , [[Pneumothorax]])
Other
Abdominal Compartment Syndrome (see Abdominal Compartment Syndrome , [[Abdominal Compartment Syndrome]])
Physiology : due to transmission of high intra-abdominal pressures to thorax -> impaired right-sided venous return
Anaphylaxis (see Anaphylaxis , [[Anaphylaxis]])
Superior Vena Cava (SVC) Syndrome (see Superior Vena Cava Syndrome , [[Superior Vena Cava Syndrome]])
Physiology : RV inflow obstruction
References
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 ]
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