RT Journal Article
SR Electronic
T1 Pulsus paradoxus
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1696
OP 1705
DO 10.1183/09031936.00138912
VO 42
IS 6
A1 Olfa Hamzaoui
A1 Xavier Monnet
A1 Jean-Louis Teboul
YR 2013
UL http://erj.ersjournals.com/content/42/6/1696.abstract
AB Systolic blood pressure normally falls during quiet inspiration in normal individuals. Pulsus paradoxus is defined as a fall of systolic blood pressure of >10 mmHg during the inspiratory phase. Pulsus paradoxus can be observed in cardiac tamponade and in conditions where intrathoracic pressure swings are exaggerated or the right ventricle is distended, such as severe acute asthma or exacerbations of chronic obstructive pulmonary disease. Both the inspiratory decrease in left ventricular stroke volume and the passive transmission to the arterial tree of the inspiratory decrease in intrathoracic pressure contribute to the occurrence of pulsus paradoxus. During cardiac tamponade and acute asthma, biventricular interdependence (series and parallel) plays an important role in the inspiratory decrease in left ventricular stroke volume. Early recognition of pulsus paradoxus in the emergency room can help to diagnose rapidly cardiac tamponade. Measurement of pulsus paradoxus is also useful to assess the severity of acute asthma as well as its response to therapy. Recent development of noninvasive devices capable of automatic calculation and display of arterial pressure variation or derived indices should help improve the assessment of pulsus paradoxus at the bedside. A discussion of the possible mechanisms and clinical implications of pulsus paradoxus http://ow.ly/p7Flt