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Inspiratory Traction on the Pericardium: The Cause of Pulsus Paradoxus in Pericardial Disease

Inspiratory Traction on the Pericardium: The Cause of Pulsus Paradoxus in Pericardial Disease Abstract The weakening of the arterial pulse during inspiration was recorded in 1854 by Vierordt, in a case of purulent pericarditis, and published the next year in his book Die Lehre vom Arterien Puls. By the time Kussmaul1 reported 4 cases of adhesive pericarditis, in 1873, it was known that rapid, deep inspiration caused a weak pulse in normal people, and normal breathing might cause it in cases of bronchial obstruction. In the cases without pericarditis it was apparent that venous pressure fell sharply during inspiration. But Kussmaul found that in 2 of his cases the jugular bulb distended even more during inspiration, and in the others little or no fall in venous pressure occurred. Pulsus paradoxus may be defined as an inspiratory drop in arterial pressure and pulsation with a rise or no significant fall in venous pressure. This occurs only in adhesive pericarditis, pericardial tamponade, or tense paramediastinal References 1. Kussmaul, A.: Über schwielige Mediastino-Pericarditis und den paradoxen Puls , Klin. Wschr. 10:443, 445, and 461, 1873. 2. Sharp, J. T.; Bunnell, I. L.; Holland, J. F.; Griffith, G. T., and Greene, D. G.: Hemodynamics During Induced Cardiac Tamponade in Man , Amer. J. Med. 29:640, 1960.Crossref 3. Gauchat, H. W., Katz, L. N.: Observations on Pulsus Paradoxus (With Special Reference to Pericardial Effusions) , Arch. Intern. Med. 33:350, 370, 1924.Crossref 4. McKusick, V. A., and Harvey, A. M.: Diseases of the Pericardium , Advance. Intern. Med. 7:157, 1955. 5. Wenckebach, K. F.: Beobachtungen bei exudativer und adhäsiver Perikarditis , Z. Klin. Med. 71:402, 1910. 6. Wood, P.: Diseases of the Heart and Circulation , Philadelphia, J. P. Lippincott Company, 1956, p. 661. 7. Chevers, N.: Diminution of the Heart and Great Vessels Following Obliteration of the Pericardial Cavity , Guy. Hosp. Rep. 7:421, 1842. 8. Lower, R.: Tractatus de corde, item de motu et colore sanguinis et chyli in eum transitu , Amsterdam, Elzevier Press, Inc., 1669, pp. 105-106. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Inspiratory Traction on the Pericardium: The Cause of Pulsus Paradoxus in Pericardial Disease

Archives of Internal Medicine , Volume 108 (6) – Dec 1, 1961

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Publisher
American Medical Association
Copyright
Copyright © 1961 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1961.03620120021004
Publisher site
See Article on Publisher Site

Abstract

Abstract The weakening of the arterial pulse during inspiration was recorded in 1854 by Vierordt, in a case of purulent pericarditis, and published the next year in his book Die Lehre vom Arterien Puls. By the time Kussmaul1 reported 4 cases of adhesive pericarditis, in 1873, it was known that rapid, deep inspiration caused a weak pulse in normal people, and normal breathing might cause it in cases of bronchial obstruction. In the cases without pericarditis it was apparent that venous pressure fell sharply during inspiration. But Kussmaul found that in 2 of his cases the jugular bulb distended even more during inspiration, and in the others little or no fall in venous pressure occurred. Pulsus paradoxus may be defined as an inspiratory drop in arterial pressure and pulsation with a rise or no significant fall in venous pressure. This occurs only in adhesive pericarditis, pericardial tamponade, or tense paramediastinal References 1. Kussmaul, A.: Über schwielige Mediastino-Pericarditis und den paradoxen Puls , Klin. Wschr. 10:443, 445, and 461, 1873. 2. Sharp, J. T.; Bunnell, I. L.; Holland, J. F.; Griffith, G. T., and Greene, D. G.: Hemodynamics During Induced Cardiac Tamponade in Man , Amer. J. Med. 29:640, 1960.Crossref 3. Gauchat, H. W., Katz, L. N.: Observations on Pulsus Paradoxus (With Special Reference to Pericardial Effusions) , Arch. Intern. Med. 33:350, 370, 1924.Crossref 4. McKusick, V. A., and Harvey, A. M.: Diseases of the Pericardium , Advance. Intern. Med. 7:157, 1955. 5. Wenckebach, K. F.: Beobachtungen bei exudativer und adhäsiver Perikarditis , Z. Klin. Med. 71:402, 1910. 6. Wood, P.: Diseases of the Heart and Circulation , Philadelphia, J. P. Lippincott Company, 1956, p. 661. 7. Chevers, N.: Diminution of the Heart and Great Vessels Following Obliteration of the Pericardial Cavity , Guy. Hosp. Rep. 7:421, 1842. 8. Lower, R.: Tractatus de corde, item de motu et colore sanguinis et chyli in eum transitu , Amsterdam, Elzevier Press, Inc., 1669, pp. 105-106.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Dec 1, 1961

References