Aetiology
The causes of pulsus paradoxus include:
- obstructive airways disease:
- during inspiration, the lower intrathoracic pressure favours the venous filling of the right ventricle more than the left
- the relative overfilling of the right ventricle may compromise the lumen of the left ventricle resulting in a lower stroke volume and lower systolic pressure
- pericardial tamponade:
- increased intra-pericardial pressure during inspiration results in a compensatory increase in central venous pressure (Kussmaul's sign)
- on the left side of the heart there is insufficient pressure to maintain the filling of the left ventricle: a low stroke volume results in a low systolic pressure
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