Pulsus Paradoxus versus Respiratory Arrhythmia - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 07-24-2009
lateus's Avatar
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 11
Threads: 2
Thanked 15 Times in 5 Posts
Reputation: 25
Stethoscope Pulsus Paradoxus versus Respiratory Arrhythmia

Pulsus Paradoxus
what is it please
I am always confusing it with respiratory arrhythmia?
Reply With Quote Quick reply to this message



  #2  
Old 07-24-2009
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 3,263
Threads: 147
Thanked 4,993 Times in 1,563 Posts
Reputation: 5089
Default

Respiratory Arrhythmia
also called Sinus Arrhythmia is a variation of the Heart Rate with respiration. Heart rate increases with inspiration and decreases with expiration, it's a physiological phenomenon and perhaps useful for the body as you don't want to wast heart beats when you have less alveolar ventilation

Pulsus Paradoxus
is decreased Systolic Pressure [hence pulse amplitude] during inspiration,
--if the decrease is less than 10 mmHg then it's physiological [it happens because at inspiration your lung vessels expand pooling more blood and so less venous return to the LEFT atrium so decreased systolic pressure another proposed mechanism of pulsus paradoxus is that during inspiration the right heart is filled with blood and if there no space for it to expand because of restrictive heart or an overinflated lungs then it will push on the left ventricle decreasing its end diastolic volume and thereby decreasing systolic blood pressure]
--if more than 10 then look for the following conditions:
Cardiac temponade or pericarditis, Asthma Croup and COPD, also Obstructive sleep apnea

You may want to know about
  • Pulsus Alternans [beat to beat variation in pulse pressure seen in systolic dysfunction],
  • Pulsus Parvus [weak upstroke seen in hypovolemia],
  • Pulsus Bisferiens [double pulsation during systole seen in LV dysfunction],
  • Pulsus Tardus [delayed upstroke, seen in AS]

Last edited by StepTaker; 12-17-2009 at 10:55 PM.
Reply With Quote Quick reply to this message
The above post was thanked by:
Doc4Step1 (08-10-2012), dr.Zh (08-10-2012), koolkiller88 (08-10-2012), MSMZ (07-06-2016), pkul85 (09-15-2013), researchmedicine (10-15-2012), shanix7 (01-13-2015), Sharer (03-09-2010), step_enhancer (08-10-2012), Taayseer (08-23-2014), tai35 (08-10-2012), wahaha007 (01-10-2010), wilderurtecho (08-10-2012)
  #3  
Old 07-24-2009
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 5
Threads: 2
Thanked 11 Times in 4 Posts
Reputation: 21
Wink How to remember Pulsus Paradoxus

There's a good way to remember Pulsus Paradoxus

You [gasp] when you are [shocked]
When you [inspire] you get [low blood pressure and tachycardia]

Reply With Quote Quick reply to this message
The above post was thanked by:
Aorta (07-28-2011), Doc4Step1 (08-10-2012), dr.Zh (08-10-2012), pkul85 (05-07-2013), wahaha007 (01-10-2010)
  #4  
Old 03-09-2010
Sharer's Avatar
USMLE Forums Scout
 
Steps History: ---
Posts: 36
Threads: 13
Thanked 586 Times in 19 Posts
Reputation: 596
Default

Finally I understood what is pulsus paradoxus
Reply With Quote Quick reply to this message
  #5  
Old 03-15-2010
Ex-USMLE Forums Staff
 
Steps History: 1+CK+CS+3
Posts: 753
Threads: 106
Thanked 2,166 Times in 464 Posts
Reputation: 2214
Arrow Differential Diagnosis of Cardiac Temponade and Right Ventricular Infarction

I'd like to add here that pulsus paradoxus is a very important differentiating clinical sign between cardiac temponade and right ventricular infarction.
Both conditions can present post-MI with hypotension, tachycardia, distended jugular veins, and clear lungs.
However, pulsus paradoxus is seen in cardiac temponade but not in right ventricular infarct.
In temponade there's no place for the right ventricle to expand when blood returns in inspiration and so it pushes on the neighboring left verntricle decreasing systolic pressure. That's not the case in right ventricular infarction where the right ventricle can still expand upon increased return in inspiration.
The distinction is crucial is treatment of temponade involves emergency pericardiocentesis while in RV infarct you give fluids to override the failure (Starling law, when the ventricle has more volume it contracts better).
Reply With Quote Quick reply to this message
The above post was thanked by:
hana (02-11-2011), MSMZ (07-06-2016), Taayseer (08-23-2014), wahaha007 (03-16-2010), wilderurtecho (08-10-2012), yarasara77 (08-03-2012)
  #6  
Old 06-24-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,259 Times in 881 Posts
Reputation: 3269
Default

Thanks....

This video is also helpful

Reply With Quote Quick reply to this message
The above post was thanked by:
badeebuty (08-23-2012), busterbee (07-28-2011), Doc4Step1 (08-10-2012), dr.Zh (08-10-2012), lokithachikkam (02-24-2016), Sadalssud (06-29-2011), samstar (01-09-2012), Shankar (06-29-2011)
  #7  
Old 06-29-2011
USMLE Forums Scout
 
Steps History: CS Only
Posts: 18
Threads: 8
Thanked 12 Times in 1 Post
Reputation: 22
Default

hey damn good video
Reply With Quote Quick reply to this message
  #8  
Old 07-27-2011
USMLE Forums Addict
 
Steps History: Step 1 Only
Posts: 157
Threads: 33
Thanked 10 Times in 9 Posts
Reputation: 20
Question pathophysiology

How does the pathophysiology of pulsus paradoxus differ in cardiac tamponade from constrictive pericarditis from asthma.

I understood that of normal systolic pressure decrease in normal inspiration and tamponade but not of asthma and pericarditis
Reply With Quote Quick reply to this message
  #9  
Old 07-27-2011
USMLE Forums Addict
 
Steps History: Step 1 Only
Posts: 157
Threads: 33
Thanked 10 Times in 9 Posts
Reputation: 20
Question Increase preload ????

Quote:
Originally Posted by lee-usmle View Post
RV infarct you give fluids to override the failure (Starling law, when the ventricle has more volume it contracts better).
Aren't we supposed to reduce preload in case of Heart failure ?
Giving fluids will raise blood volume thus raise preload, increased preload will add more workload on the already failing heart. What I remember is we tend to give venodilators to reduce preload and reduce venous return !!!

Correct me please!!!!!:sorry::sorry::sorry::sorry:
Reply With Quote Quick reply to this message
  #10  
Old 07-27-2011
Breex's Avatar
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 51
Threads: 3
Thanked 27 Times in 17 Posts
Reputation: 37
Default

Quote:
Originally Posted by drzamzam View Post
Aren't we supposed to reduce preload in case of Heart failure ?
Giving fluids will raise blood volume thus raise preload, increased preload will add more workload on the already failing heart. What I remember is we tend to give venodilators to reduce preload and reduce venous return !!!

Correct me please!!!!!:sorry::sorry::sorry::sorry:
Dude, he did not say heart failure, he said right ventricular infarction.
Check the treatment here
http://emedicine.medscape.com/articl...nt#aw2aab6b6b2
You give fluids to these patients
Reply With Quote Quick reply to this message
  #11  
Old 08-10-2012
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 8
Threads: 5
Thanked 1 Time in 1 Post
Reputation: 11
Default Bainbridge reflex is the name of that explanation in respiratory arrhythmia!

Quote:
Originally Posted by StepTaker View Post
Respiratory Arrhythmia
also called Sinus Arrhythmia is a variation of the Heart Rate with respiration. Heart rate increases with inspiration and decreases with expiration it's a physiological phenomenon and perhaps useful for the body as you don't want to wast heart beats when you have less alveolar ventilation Bain

Pulsus Paradoxus
is decreased Systolic Pressure [hence pulse amplitude] during inspiration,
--if the decrease is less than 10 mmHg then it's physiological [it happens because at inspiration your lung vessels expand pooling more blood and so less venous return to the LEFT atrium so decreased systolic pressure another proposed mechanism of pulsus paradoxus is that during inspiration the right heart is filled with blood and if there no space for it to expand because of restrictive heart or an overinflated lungs then it will push on the left ventricle decreasing its end diastolic volume and thereby decreasing systolic blood pressure]
--if more than 10 then look for the following conditions:
Cardiac temponade or pericarditis, Asthma Croup and COPD, also Obstructive sleep apnea

You may want to know about
  • Pulsus Alternans [beat to beat variation in pulse pressure seen in systolic dysfunction],
  • Pulsus Parvus [weak upstroke seen in hypovolemia],
  • Pulsus Bisferiens [double pulsation during systole seen in LV dysfunction],
  • Pulsus Tardus [delayed upstroke, seen in AS]
(((Bainbridge Reflex))) Inspiration increase HR and vice versa.
Reply With Quote Quick reply to this message



Reply

Tags
Cardiology-, Clinical-Signs, Videos-Animations

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Pulsus Paradoxus StepTaker USMLE Step 1 Mnemonics 3 12-24-2011 07:09 PM
Upper & Lower Respiratory Tract Infection? achistikbenny USMLE Step 1 Forum 7 10-17-2011 09:41 PM
Function of respiratory Clara cells! Gulara USMLE Step 1 Forum 7 05-02-2011 02:13 PM
Respiratory Physical Exam Question good_boy_1234 USMLE Step 2 CK Forum 6 03-17-2011 04:59 PM
respiratory pathology ecgram USMLE Step 1 Forum 3 05-22-2010 01:21 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)