The ultimate pulsus paradoxus: failure of aortic valve opening with inspiration

Pulse‐Wave Doppler Interrogation of the Abdominal Aorta: A Window to the Left Heart and Vasculature

“…27 Pulsus paradoxus: Significant respiratory variability in flow velocity is noted in the aorta with considerable inspiratory decrease in the systolic wave TVI. Both the peak systolic velocity and systolic wave duration are reduced during inspiration as compared to expiration 28 (Fig. 2F).…”

“…26 Pulsus alternans: Pulse Doppler of the abdominal aorta shows a beat-to-beat variability in waveform pattern with alternating higher and lower peak velocities at a constant rhythm and RR interval (Fig. Both the peak systolic velocity and systolic wave duration are reduced during inspiration as compared to expiration 28 (Fig. 27 This pattern results from an alternating LV stroke volume.…”

Pulsus paradoxus

“…An important echocardiographic sign of severe PP is the failure to open the atrio-ventricular (AV) valve during systole, resulting in reduced left ventricular preload and LVSV. 46 PP is not present in all patients with cardiac tamponade. It may be absent in the presence of the following co-morbidities: atrial septal defect (ASD), 47,48 elevated left ventricular end-diastolic pressure, 49,50 aortic regurgitation, severe aortic stenosis, 51 regional tamponade, low-pressure cardiac tamponade, 52 pulmonary artery obstruction, 53 aortic dissection leading to hemopericardium, 11 extreme hypotension, 54 and severe musculoskeletal chest abnormalities.…”

“…Ditchey et al proposed that selective compression of the right heart by cardiac tamponade reduced right ventricular stroke volume and pulmonary venous flow, resulting in a reduction in LVEDV and LVSV. An important echocardiographic sign of severe PP is the failure to open the atrio‐ventricular (AV) valve during systole, resulting in reduced left ventricular preload and LVSV . PP is not present in all patients with cardiac tamponade.…”