{"id":21478,"date":"2016-08-09T05:16:56","date_gmt":"2016-08-08T23:46:56","guid":{"rendered":"https:\/\/cardiophile.org\/?p=21478"},"modified":"2016-08-09T05:16:56","modified_gmt":"2016-08-08T23:46:56","slug":"mechanism-of-reverse-pulsus-paradoxus","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/mechanism-of-reverse-pulsus-paradoxus\/","title":{"rendered":"Mechanism of reverse pulsus paradoxus"},"content":{"rendered":"<h2><span style=\"color: #008000;\">Mechanism of reverse pulsus paradoxus<\/span><\/h2>\n<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/ltq2Q5SCgzQ\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen=\"\"><\/iframe><\/p>\n<p>Mechanism of reverse pulsus paradoxus: Reverse pulsus paradoxus is an expiratory fall in pulse volume, the opposite of <a href=\"https:\/\/johnsonfrancis.org\/professional\/pulsus-paradoxus\/\">pulsus paradoxus<\/a>. The classical causes of reverse pulsus paradoxus described are [1]:<\/p>\n<ol>\n<li>Isorhythmic atrioventricular (AV) dissociation<\/li>\n<li>Hypertrophic obstructive cardiomyopathy<\/li>\n<li>Intermittent positive pressure ventilation (IPPV)<\/li>\n<\/ol>\n<p>During IPPV the swings in intrathoracic pressure is opposite to that of normal breathing. Hence the inspiratory blood pressure is higher than the expiratory blood pressure [2]. During the inspiratory phase, increased intrathoracic pressure of positive pressure ventilation is transmitted to the thoracic aorta. In addition there is an increase in left ventricular stroke volume [3]. The occurrence of reverse pulsus paradoxus during IPPV has also been called as respirator paradox [4]. It has been mentioned that respirator paradox after cardiac surgery may delay the early diagnosis of cardiac tamponade. Reverse pulsus paradoxus in a patient on IPPV is thought to be a sensitive indicator of hypovolemia [5]. Left ventricular end systolic volume as measured by radionuclide imaging is reduced during inspiratory phase of IPPV without significant change in end diastolic volume. This would suggest a reduced left ventricular afterload in inspiratory phase as a mechanism for reverse pulsus paradoxus in IPPV [6].<\/p>\n<p>In hypertrophic obstructive cardiomyopathy, Massumi RA et al [1] have documented higher left ventricular pressures and lower arterial pressures in expiration with simultaneous left ventricular-brachial arterial pressures. This would suggest an enhanced left ventricular outflow obstruction in expiration.<\/p>\n<p>In case of isorhythmic AV dissociation, inspiratory increase in sinus rate results in sinus rhythm dominating over AV dissociation. In sinus rhythm there is AV synchrony and hence a higher pulse volume, compare to AV dyssynchrony in expiration.<\/p>\n<p><span style=\"color: #0000ff;\"><strong>References<\/strong><\/span><\/p>\n<ol>\n<li>Massumi RA, Mason DT, Vera Z, Zelis R, Otero J, Amsterdam EA. Reversed pulsus paradoxus.&nbsp;N Engl J Med. 1973 Dec 13;289(24):1272-5.<\/li>\n<li>Robotham JL, Cherry D, Mitzner W, Rabson JL, Lixfeld W, Bromberger-Barnea B. A re-evaluation of the hemodynamic consequences of intermittent positive pressure ventilation. Crit Care Med. 1983 Oct;11(10):783-93.<\/li>\n<li>Wong FW. Pulsus paradoxus in ventilated and non-ventilated patients.&nbsp;Dynamics. 2007 Fall;18(3):16-8.<\/li>\n<li>Rick JJ, Burke SS. Respirator paradox. South Med J. 1978 Nov;71(11):1376-8, 1382.<\/li>\n<li>Khasnis A, Lokhandwala Y. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12082330\">Clinical signs in medicine: pulsus paradoxus<\/a>. J Postgrad Med. 2002 Jan-Mar;48(1):46-9.<br \/>\nAbel JG, Salerno TA, Panos A, Greyson ND, Rice TW, Teoh K,<\/li>\n<li>Lichtenstein SV. Cardiovascular effects of positive pressure ventilation in humans. Ann Thorac Surg. 1987 Feb;43(2):198-206.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Mechanism of reverse pulsus paradoxus Mechanism of reverse pulsus paradoxus: Reverse pulsus paradoxus is an expiratory fall in pulse volume, the opposite of pulsus paradoxus. The classical causes of reverse pulsus paradoxus described are [1]: Isorhythmic atrioventricular (AV) dissociation Hypertrophic obstructive cardiomyopathy Intermittent positive pressure ventilation (IPPV) During IPPV the swings in intrathoracic pressure is [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":32784,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[2],"tags":[1755,1881,1934,1948,3291],"class_list":["post-21478","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cardiology","tag-hypertrophic-obstructive-cardiomyopathy","tag-intermittent-positive-pressure-ventilation","tag-ippv","tag-isorhythmic-atrioventricular-av-dissociation","tag-respirator-paradox"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Mechanism of reverse pulsus paradoxus - 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