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Pulsus Paradoxus

PP


Presentation

  • Cardiac extrinsic compression and anatomic cardiac abnormalities were not present. Dynamic magnetic resonance imaging (MRI) demonstrated inspiratory inferior vena cava (IVC) compression at the diaphragm.[ncbi.nlm.nih.gov]
  • Pulsus paradoxus (fluctuation of 10 mm Hg or greater) was present on 110 occasions.[ncbi.nlm.nih.gov]
  • A case study is also included to illustrate the presentation and treatment of pulsus paradoxus in a mechanically ventilated patient.[ncbi.nlm.nih.gov]
  • Two thirds of the subjects presented pulsus paradoxus.[ncbi.nlm.nih.gov]
  • A patient with a strangulated diaphragmatic hernia presented as an emergency and was noted to have pulsus paradoxus. The mechanism of this physical sign, previously unrecorded in association with an intrathoracic hernia, is discussed.[ncbi.nlm.nih.gov]
Physician
  • OBJECTIVE: Determination of physician accuracy in measuring PP.[ncbi.nlm.nih.gov]
  • ED physicians equipped with a PP monitor would be able to objectify the work of breathing and would more closely adhere to NAEPP guidelines.[ncbi.nlm.nih.gov]
  • Abstract Pulsus paradoxus has interested physicians for more than a century.[ncbi.nlm.nih.gov]
  • Although the PP technique can easily be learned by physician and nursing personnel, there are potential problems. The difficulties in children are compared to those in adults.[ncbi.nlm.nih.gov]
  • Crit Care Med. 2013;41:2618–2626 [ MEDLINE ] Advanced echocardiography for the critical care physician: Part 1. Chest. 2014;145:129–134 [ MEDLINE ] Advanced echocardiography for the critical care physician: Part 2. Chest. 2014;145:135–142 [ MEDLINE ][mdnxs.com]
Hypoxemia
  • A 59-year-old male underwent polysomnography that showed sleep hypoxemia, obstructive sleep-disordered breathing (apnea hypopnea index [AHI] 5.1and respiratory disturbance index [RDI] 87.9), with variations of pulse pressure induced primarily by inspiration[ncbi.nlm.nih.gov]
Respiratory Disorders
  • PATIENTS: 62 nonintubated children with or without respiratory disorders. DESIGN: Prospective, clinical study.[ncbi.nlm.nih.gov]
  • It is also the most common chronic respiratory disorder in adults. It results in over 1.7 million emergency department visits and about 450,000 hospitalizations annually in the U.S. alone.[grantome.com]
  • In respiratory disorders: Increased airway resistance: There is wide excursion of intrathoracic pressure during inspiration and expiration.[epomedicine.com]
  • According to the articles I looked at, the pathophysiology of pulsus paradoxus accompanying respiratory disorders is complex and in many parts unclear.[forums.studentdoctor.net]
Regurgitation
  • No evidence could be found for an atrial septal defect, significant aortic regurgitation, elevated left ventricular diastolic pressure, or localized tamponade, previously described disorders in which pulsus paradoxus may not be seen when tamponade occurs[ncbi.nlm.nih.gov]
  • The clinical detection of PP is sometimes nebulous, especially during haemopericardium due to aortic dissection and aortic valve regurgitation, or when large atrial septal defects coexist.[ncbi.nlm.nih.gov]
  • Never heard of it in aortic regurgitation and can't even think any mechanism in which it will lead to this! My choice will be aortic regurgitation.[medicowesome.com]
  • […] pulsus [ pul sus ] ( L. ) pulsus bisfe riens a pulse characterized by two strong systolic peaks separated by a midsystolic dip, most commonly occurring in pure aortic regurgitation with stenosis. pulsus dif ferens inequality of the pulse observable at[medical-dictionary.thefreedictionary.com]
  • Pulsus paradoxus may be absent in Cardiac tamponade if associated with: Atrial Septal Defect Ventricular Septal Defect Aortic Regurgitation Pericardial adhesions Isolated right cardiac tamponade Conditions causing reverse pulsus paradoxus Bedside Measurement[epomedicine.com]
Left Ventricular Dysfunction
  • Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the survival and ventricular enlargement trial. ‎ Seite 248 - Group.[books.google.de]
  • Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the survival and ventricular enlargement trial. ‏ الصفحة 248 - Group.[books.google.com]
  • Hoit BD, Ramrakhyani K (1991) Pulmonary venous flow in cardiac tamponade: influence of left ventricular dysfunction and the relation to pulsus paradoxus. J Am Soc Echocardiogr 4: 559–570. View Article Google Scholar 19.[journals.plos.org]
Impulsivity
  • Our primary objective was to examine whether pulse oximeter plethysmograph estimate of pulsus paradoxus (PEP) is associated with physiologic and symptom measures of acute exacerbation severity (airway resistance by impulse oscillometry [%IOS] and the[ncbi.nlm.nih.gov]
  • The paradox described by Kussmaul was a “pulse simultaneously slight and irregular, disappearing during inspiration and returning upon expiration” despite the continued presence of the cardiac impulse during both respiratory phases.[clinicalmedicineupdate.blogspot.com]
  • In all three, it was rapid, almost always more than 100, the impulse of low amplitude, the tension soft, and the rhythm paradoxical in two ways: (1) despite continuing action of the heart, the pulse disappeared for short intervals at the palpating finger[priory.com]
  • The paradox described by Adolf Kussmaul in 1873 was a “pulse simultaneously slight and irregular, disappearing during inspiration and returning upon expiration”, despite the continued presence of the cardiac impulse during both respiratory phases.SERIES[doi.org]

Workup

  • Jugular Venous Distention Workup 6. ER Chest Pain Workup 7. Cardiac Examination for Internal Medicine 8. FAQ on Blood Pressure 9.[rahulgladwin.com]
Ejection Fraction Decreased
  • In other words, with these cardiomyopathies, as LV filling decreases, ejection fraction decreases directly, yet non-linearly and with a negative concavity (negative first and second derivatives).[en.wikipedia.org]
Ventricular Hypertrophy
  • We observed this phenomenon in a patient with a large pericardial effusion, right ventricular failure, and pulmonary arterial hypertension, and we noted the lack of echocardiographic features of tamponade in the presence of right ventricular hypertrophy[ncbi.nlm.nih.gov]

Treatment

  • Change of PEP after 2 hours of treatment was associated with change of %FEV1 (p 0.001) and change of the AAIRS (p 0.01) but not with change of %IOS (p 0.60).[ncbi.nlm.nih.gov]
  • The mean PP was significantly greater in patients who were admitted for further treatment at all time points (P .003 or P .002).[ncbi.nlm.nih.gov]
  • PEP correlates with airway resistance at baseline and is associated with accessory muscle use at baseline and at 2 and 4 hours after initiation of treatment.[ncbi.nlm.nih.gov]
  • The presence of pulsus paradoxus in OSAS indicates a marked increase in Pes nadir, and its disappearance with nasal CPAP may be one of the signs of effective treatment of OSAS.[ncbi.nlm.nih.gov]
  • A correlation between the percent drop of pulsus paradoxus and success or failure of treatment was noted. Treatment failure was the most frequent criterion for admission.[ncbi.nlm.nih.gov]

Prognosis

  • […] which will compress the left ventricle compression of the left ventricle decreased filling of the left heart decreased blood pressure Associated conditions ruptured ascending aortic dissection ventricular free wall rupture from myocardial infarction Prognosis[medbullets.com]
  • Description FIELD OF THE INVENTION The invention relates to a device and method for the diagnosis, prognosis, and monitoring of patients afflicted with a variety of clinical syndromes such as asthma, croup, tension pneumothorax, pericardial tamponade,[google.sr]

Etiology

  • At the same change in PpI, there was no significant difference between "intercostal" and "abdominal" breathing, suggesting that pulmonary overdistention with tensing of the mediastinum is not an important etiologic mechanism.[ncbi.nlm.nih.gov]
  • With early recognition of this clinical sign, prompt treatment of the underlying etiology can produce a more desirable outcome.[swjpcc.com]
  • Definition Pulsus Paradoxus : decreased systolic blood pressure with inspiration Observed in Arterial Line Waveform (see Arterial Line, [[Arterial Line]]) Etiology Cardiac Cardiogenic Shock (see Cardiogenic Shock, [[Cardiogenic Shock]]) Constrictive Pericarditis[mdnxs.com]
  • Although 12 lead ECG evaluation is an essential part of patient assessment, especially cardiac etiology, understanding basic cardiac function plays a major role during treatment and overall patient status.[ems12lead.com]
  • Further evaluation of patients with pulsus paradoxus will depend on the etiology.[statpearls.com]

Epidemiology

  • : pulsus paradoxus is less common in constrictive pericarditis Hypovolemia (see Hypovolemic Shock, [[Hypovolemic Shock]]) Epidemiology : in sepsis Respiratory Pulse Pressure Variation, Delta PP ((Max-Min Pulse Pressure)/Average Pulse Pressure), Predicts[mdnxs.com]
  • Epidemiology The epidemiology of pulsus paradoxus is difficult to define due to the heterogeneity of the diseases that lead to its manifestation. The incidence of cardiac tamponade leading to pulsus paradoxus has been poorly documented.[statpearls.com]
  • Introduction Clinical definition accumulation of fluid in the pericardial sac that restricts ventricular filling Epidemiology risk factors pericarditis malignancy uremia systemic lupus erythematosus malignancy tuberculosis penetrating trauma Etiology[medbullets.com]
Sex distribution
Age distribution

Pathophysiology

  • Model 2 revealed the three major factors determining the respiratory displacement of IVS in normal and different pathophysiological conditions: the magnitude of RIPC, the pressure difference between the two ventricles and the intrapericardial pressure[ncbi.nlm.nih.gov]
  • BACKGROUND: Pulsus paradoxus (PP) is a pathophysiologic parameter that is indicative of asthma severity.[ncbi.nlm.nih.gov]
  • Practical Cardiovascular Hemodynamics provides an in-depth understanding of waveforms and tracings seen in various disease states as well as pathophysiology behind those findings.[books.google.de]
  • Pulsus paradoxus in cardiac tamponade: a pathophysiology continuum. Clin Cardiol. 2003;26(5):215-7. [CrossRef] [PubMed] Cite as: Thao C, Hasan M, Babary H, Luraschi C. Medical image of the week: pulsus paradoxus.[swjpcc.com]
  • Mechanisms of Clinical Signs is the first consolidated text of its kind; designed to help medical students and junior doctors understand the pathophysiological mechanisms behind clinical signs.[books.google.com]

Prevention

  • A table designed to support the echocardiographic probe prevented significant sleep disturbances during monitoring and allowed continuous data collection with and without nasal CPAP administration.[ncbi.nlm.nih.gov]
  • Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. ‎[books.google.de]
  • Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. ‏[books.google.com]
  • The ability of PP to categorize acutely asthmatic patients in accordance with the earlier National Asthma Education and Prevention Program (NAEPP) expert panel report 1 guidelines was determined.[ncbi.nlm.nih.gov]
  • This increase in pressure prevents the heart chambers from collapsing. And the increased heart rate preserves cardiac output despite decreased stroke volume.[openanesthesia.org]

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