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Cardio Exam

Pulsus Paradoxus

July 1st, 2020


The systolic blood pressure normally drops slightly during inspiration, though an exaggerated fall in SBP with inspiration is abnormal. While classically a sign of tamponade, pulsus paradoxus may also occur in several other cardiorespiratory conditions.
  • How to Elicit

  • Inflate the sphygmomanometer above systolic pressure and slowly reduce the cuff until the 1st Korotkoff sound can be heard only during expiration. Slowly reduce the cuff until the 1st Korotkoff sound can be heard during both inspiration and expiration.
  • Interpretation

  • Pulsus paradoxus is present if the systolic blood pressure drops 10mmHg or more during inspiration.
  • Causes of Pulsus Paradoxus

  • Cardiac - tamponade, constrictive pericarditis, severe CCF, myocardial pathology, mitral / tricuspid stenosis
  • Respiratory - acute asthma, pulmonary embolism, emphysema
  • Hypovolaemic shock
  • Extreme obesity
  • Ascites
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