Question:
Non-clinical question: Pulsus paradoxus is seen in which of the following conditions?
Non-clinical question: Pulsus paradoxus is seen in which of the following conditions?
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Causes of Pulsus Paradoxus ($>10$ mmHg drop in systolic BP on inspiration):
1. Cardiac Tamponade.
2. Massive Pulmonary Embolism.
3. Severe Asthma or COPD.
4. Constrictive Pericarditis (in about 1/3 of cases).
1. Cardiac Tamponade.
2. Massive Pulmonary Embolism.
3. Severe Asthma or COPD.
4. Constrictive Pericarditis (in about 1/3 of cases).
Updated On: Sep 3, 2026
- Cardiac tamponade
- Pleural effusion
- Pulmonary embolism
- Both a and c
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The Correct Option is D
Solution and Explanation
Concept:
Pulsus paradoxus is an exaggeration of the normal physiological drop in systolic blood pressure during inspiration. It is defined as a fall in systolic blood pressure of $>10$ mmHg during the inspiratory phase of respiration.
Explanation:
• During inspiration, negative intrathoracic pressure increases venous return to the right heart, enlarging the right ventricle (RV).
• Under normal conditions, the RV expands outward. However, in Cardiac Tamponade (Option A), the fluid-filled, inelastic pericardial sac prevents the RV from expanding outward. Instead, the RV free wall pushes the interventricular septum to the left, encroaching on the left ventricular (LV) volume. This decreases LV stroke volume and causes a significant drop in systolic blood pressure during inspiration (pulsus paradoxus).
• Similarly, in a massive Pulmonary Embolism (PE) (Option C), the sudden and extreme obstruction to right ventricular outflow causes acute severe RV pressure and volume overload (cor pulmonale). The grossly distended RV forces the interventricular septum to bow into the LV, again decreasing LV filling and stroke volume, yielding a pulsus paradoxus.
• Severe obstructive lung disease (Asthma/COPD) is another classic cause due to exaggerated negative intrathoracic pressure swings.
• A simple pleural effusion (Option B) does not mechanically constrain the entire heart in a way that causes significant ventricular interdependence, and therefore does not typically cause pulsus paradoxus.
Final Answer:
Pulsus paradoxus is a hallmark of ventricular interdependence and is classically seen in both cardiac tamponade and massive pulmonary embolism.
Pulsus paradoxus is an exaggeration of the normal physiological drop in systolic blood pressure during inspiration. It is defined as a fall in systolic blood pressure of $>10$ mmHg during the inspiratory phase of respiration.
Explanation:
• During inspiration, negative intrathoracic pressure increases venous return to the right heart, enlarging the right ventricle (RV).
• Under normal conditions, the RV expands outward. However, in Cardiac Tamponade (Option A), the fluid-filled, inelastic pericardial sac prevents the RV from expanding outward. Instead, the RV free wall pushes the interventricular septum to the left, encroaching on the left ventricular (LV) volume. This decreases LV stroke volume and causes a significant drop in systolic blood pressure during inspiration (pulsus paradoxus).
• Similarly, in a massive Pulmonary Embolism (PE) (Option C), the sudden and extreme obstruction to right ventricular outflow causes acute severe RV pressure and volume overload (cor pulmonale). The grossly distended RV forces the interventricular septum to bow into the LV, again decreasing LV filling and stroke volume, yielding a pulsus paradoxus.
• Severe obstructive lung disease (Asthma/COPD) is another classic cause due to exaggerated negative intrathoracic pressure swings.
• A simple pleural effusion (Option B) does not mechanically constrain the entire heart in a way that causes significant ventricular interdependence, and therefore does not typically cause pulsus paradoxus.
Final Answer:
Pulsus paradoxus is a hallmark of ventricular interdependence and is classically seen in both cardiac tamponade and massive pulmonary embolism.
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