Why Does Pulsus Paradoxus Occur?

Marcus Vance
Marcus Vance
• • 6 min read

Pulsus Paradoxus Results from Alterations in the Mechanical Forces Imposed on the Chambers of the Heart and Pulmonary Vasculature and Is Often Due to...

Why Does Pulsus Paradoxus Occur?

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

cardiac tamponade
A mediastinal mass is often associated with a pericardial effusion, or may exert direct compression of the superior vena cava, right ventricle, or right ventricular outflow tract, resulting in tamponade-like physiology (1).
and to a lesser degree constrictive pericarditis
constrictive pericarditis
Individuals with constrictive pericarditis exhibit features of both right and left heart failure. Constrictive pericarditis is a rare cause of heart failure, with increasing prevalence, and the diagnosis is often missed [2-3,5-6].
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What is pulsus paradoxus and why does it occur?

Pulsus paradoxus (a decrease in the systolic blood pressure during inspiration) results from a decrease in cardiac stroke volume with inspiration due to greatly increased left-ventricular afterload.

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Why there is pulsus paradoxus in cardiac tamponade?

Moderate to severe cardiac tamponade, and occasionally constrictive pericarditis, induce hemodynamic changes that enhance the inspiratory fall in systolic blood pressure. This exaggerated drop in systemic blood pressure during inspiration is termed pulsus paradoxus (waveform 1 and waveform 2).

Marcus Vance

Marcus Vance

Cybersecurity & Digital Privacy Researcher
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Marcus Vance is a cybersecurity auditor and technology writer dedicated to educating the public about online safety, data privacy regulations, enterprise security, and emerging cyber threats.