Pulsus paradoxus is an exaggeration of a normal physiological phenomenon, where pulse decreases on inspiration due to shifting of the ventricular septum from the influx of blood into the right heart. As such, PP is also associated with Kussmaul’s sign.
PP is indicative of cardiac tamponade (Beck’s Triad), pericarditis, chronic sleep apnea, croup, and obstructive lung disease.
Quantifying PP: Deflate BP cuff slowly, until the 1st Korotkoff sound is heard only on expiration. Then slowly deflate the cuff until it can be heard on both inspiration and expiration. PP exists if the difference in pressure is >10mmHg
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