Pulsus Paradoxus

Pulsus paradoxus is an important finding in cardiac tamponade. It can also occur in chronic obstructive pulmonary disease. It is rare in constrictive pericarditis. It may also be rarely observed in pulmonary embolism, marked obesity, pregnancy and partial obstruction of the superior vena cava. On the other hand, in those with aortic regurgitation and atrial septal defect, pulsus paradoxus may not occur even if there is associated cardiac tamponade [Textbook of cardiovascular medicine, by Eric J. Topol, Robert M. Califf. Chapter 16, Page 197]. Reverse pulsus paradoxus (inspiratory rise of arterial pressure) may be noted in hypertrophic cardiomyopathy, intermittent positive pressure ventilation and isorhythmic AV dissociation. (source: cardiophile.org)

Pericardial Effusion: Tamponade or not

Pulsus Paradoxus may not be present in Tamponade if with:

1. Severe Hypotension

2. Severe LV dysfunction

3. Aortic Regurgitation

4. Atrial Septal Defect