What is a positive pulsus paradoxus?
Pulsus paradoxus, also paradoxic pulse or paradoxical pulse, is an abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mmHg. When the drop is more than 10 mmHg, it is referred to as pulsus paradoxus.
Is pulsus paradoxus palpable?
Pulsus paradoxus is detected by palpating the pulse or using the blood pressure cuff, although only paradoxical pulses exceeding 15 to 20 mm Hg are palpable. For this reason, most clinicians use the blood pressure cuff, which has the added advantage of quantifying the finding (Fig.
How do I take the pulsus exam?
Technique
- Inflate the bladder quickly to 20 mmHg above the pressure at which radial pulse is blocked.
- Deflate the bladder 3 mmHg/sec, record the pressure at which the first Korotkoff sound is heard as the systolic pressure.
- Continue deflating, record the disappearance of Korotkoff sounds as the diastolic pressure.
Where is the paradoxical pulse?
By common consent, the term paradoxical pulse, or “pulsus paradoxus,” is considered to refer to a phenomenon in which the peripheral pulse is markedly diminished, or even abolished, during ordinary or quiet inspiration; it promptly reappears during expiration.
How do you test for pulsus paradoxus?
Dr. Ronald Witteles is certified in Internal Medicine and Cardiology. He serves as the Stanford Internal Medicine Program Director, Associate Director of the CCU and Co-Director, Stanford Amyloid Center. When testing for pulsus paradoxus, simply focus on the korotkoff sounds.
What is pulsus paradoxus?
History and Physical Pulsus paradoxus is a clinical exam finding that may be seen in a variety of disease processes. It is a key exam finding in pericardial effusion as it may herald cardiac tamponade.
How is pulsus paradoxus measured in patients with Korotkoff syndrome?
For patients without indwelling arterial access, pulsus paradoxus is best measured with a manual sphygmomanometer and stethoscope. Automatic blood pressure cuffs cannot accurately measure for pulsus paradoxus. Assessment is made by inflating the cuff until all Korotkoff are absent, then very slowly releasing pressure from the cuff.
What is the treatment for pulsus paradoxus?
Treatment / Management Pulsus paradoxus is not a disease state. It is a physiologic manifestation of an underlying disease process and treatment should address the underlying pathology. If cardiac tamponade is suspected and pulsus paradoxus is present, consideration should be made for urgent or emergent pericardiocentesis.