PULSUS PARADOXUS

Course overview

PULSUS PARADOXUS REFERS TO A SYSTOLIC PRESSURE DROP GREATER THAN 10MMHG DURING INSPIRATION. PULSUS PARADOXUS RESULTS FROM ALTERATIONS IN THE MECHANICAL FORCES IMPOSED ON THE CHAMBERS OF THE HEART AND PULMONARY VASCULATURE AND IS OFTEN DUE TO PERICARDIAL DISEASE, PARTICULARLY CARDIAC TAMPONADE AND TO A LESSER DEGREE CONSTRICTIVE PERICARDITIS. HOWEVER, IT IS IMPORTANT TO RECOGNIZE THAT PULSUS PARADOXUS MAY BE SEEN IN NON-PERICARDIAL CARDIAC DISEASES SUCH AS RIGHT VENTRICULAR MYOCARDIAL INFARCTION AND RESTRICTIVE CARDIOMYOPATHY. ADDITIONALLY, NON-CARDIAC CONDITIONS, INCLUDING PULMONARY DISEASES LIKE SEVERE CHRONIC OBSTRUCTIVE PULMONARY DISEASE, ASTHMA, TENSION PNEUMOTHORAX, LARGE BILATERAL PLEURAL EFFUSION, AND PULMONARY EMBOLISM CAN LEAD TO PULSUS PARADOXUS. OTHER CAUSES INCLUDE ANY CONDITION RESULTING IN CARDIAC COMPRESSION, SUCH AS IATROGENIC COMPRESSION DURING SURGERY, MARKED OBESITY, AND PECTUS EXCAVATUM. FINALLY, PULSUS PARADOXUS MAY ALSO MANIFEST SECONDARY TO SEVERE HYPOVOLEMIC SHOCK. THIS ACTIVITY DESCRIBES THE PATHOPHYSIOLOGY, EVALUATION, AND MANAGEMENT OF PULSUS PARADOXUS AND HIGHLIGHTS THE ROLE OF THE INTERPROFESSIONAL TEAM IN THE CARE OF PATIENTS WITH PULSUS PARADOXUS.