Pulsus paradoxus
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In medicine, a pulsus paradoxus (PP), also paradoxic pulse and paradoxical pulse, is an exaggeration of the normal variation in the pulse during the inspiratory phase of respiration, in which the pulse becomes weaker as one inhales and stronger as one exhales. It is a sign that is indicative of several conditions including cardiac tamponade and lung diseases (e.g. asthma, COPD).[1]
The paradox in pulsus paradoxus is that, on clinical examination, one can detect extra beats on cardiac auscultation, during inspiration, when compared to the radial pulse.[1] It results from an accentuated decrease of the blood pressure, which leads to the (radial) pulse not being palpable and may be accompanied by an increase in the jugular venous pressure height (Kussmaul sign). As is usual with inspiration, the heart rate is increased, due to the increased venous return.
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[edit] Measurement of PP
PP is quantified using a blood pressure cuff and stethoscope, by measuring the variation of the pressure in systole with respiration. Normal systolic blood pressure variation (with respiration) is considered to be 10 mmHg.[1] Pulsus paradoxus is an inspiratory reduction in systolic pressure >10 mmHg. Pulsus paradoxus can also be measured by listening to Korotkoff sounds, and hearing the actual sound of the systolic beat. If the pressure gradient is >10mmHg, then it can be classified as pulsus paradoxus.
[edit] Predictive value for tamponade
PP has been shown to be predictive of the severity of cardiac tamponade.[2]
[edit] Cause of Pulsus Paradoxus
During inspiration, both systolic and diastolic blood pressure normally decrease. This is because the intrathoracic pressure becomes more negative, blood pools in the pulmonary vessels and thus left-heart filling is reduced.
When this normal reduction is exaggerated, it is termed Pulsus Paradoxus, meaning that there was a fall in blood pressure and a paradoxical rise in pulse rate [3].
This may occur with constrictive pericarditis, pericardial effusion or severe asthma.
[edit] References
- ^ a b c Khasnis A, Lokhandwala Y. Clinical signs in medicine: pulsus paradoxus. J Postgrad Med. 2002 Jan-Mar;48(1):46-9. PMID 12082330. Full Text.
- ^ Curtiss EI, Reddy PS, Uretsky BF, Cecchetti AA. Pulsus paradoxus: definition and relation to the severity of cardiac tamponade. Am Heart J. 1988 Feb;115(2):391-8. PMID 3341174.
- ^ Talley J, O'connor S. Clinical Examination: A systemic guide to Physical Diagnosis. Elsevier Churchill Livingstone 2006
[edit] See also
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