Physical examination maneuver

Physical Exam

Pulsus Paradoxus

also known as Paradoxical pulse
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How to Perform

Choose an appropriately-sized blood pressure cuff and wrap it around the upper arm with the artery marker centered over the brachial artery. Place the stethoscope in your ears, palpate the brachial or radial pulse while inflating the cuff, and inflate to about 30 mmHg above the point where the pulse disappears. Place the stethoscope over the brachial artery and deflate the cuff very slowly until the repetitive tapping sounds (Korotkoff sounds) become audible only during expiration and disappear during inspiration; note that pressure. Then continue to deflate the cuff slowly and note the pressure at which Korotkoff sounds become audible during both inspiration and expiration. Pulsus paradoxus is present if the difference between the two pressures is greater than 10 mmHg.

How to Interpret

Showing 2 of 5 findings

Asthma Exacerbation

Pulsus paradoxus in a patient with an acute asthma exacerbation
Rule in
Somewhat helpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Moderate

Cardiac Tamponade

Pulsus paradoxus (>10 mm Hg)
Rule in
Somewhat helpful
Rule out
Very helpful
Evidence:Moderate

Related Bedside Tests

Oxygen SaturationMembers
Sign in
Oxygen Saturation
aka Pulse oximetry
Rule in:HMortality, SHPneumonia, MHCardiac Tamponade +8 more
Rule out:ICCardiac Tamponade, NHHepatopulmonary Syndrome, NHMortality +8 more
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Jugular Venous Pressure
Rule in:VHShock, HRight Ventricular Infarction, SHElevated Pulmonary Capillary Wedge Pressure +14 more
Rule out:HRight Ventricular Infarction, SHElevated Pulmonary Capillary Wedge Pressure, SHPulmonary Hypertension +14 more
🎬Video coming soon
Blood Pressure
Rule in:VHHypovolemia, VHMortality, VHStructural Brain Lesion +22 more
Rule out:VHCardiac Tamponade, VHHypovolemia, HLow Cardiac Output +22 more
Heart RateMembers
Sign in
Heart Rate
Rule in:SHAtrial Fibrillation, SHDecompensation, SHHypothyroidism +15 more
Rule out:HDecompensation, SHAtrial Fibrillation, SHPostoperative Complication +15 more
Cardiac AuscultationMembers
Sign in
Cardiac Auscultation
Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy +37 more
Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy, VHRight-sided Valvular Lesion +37 more
Carotid Artery PalpationMembers
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Carotid Artery Palpation
Rule in:HAortic Stenosis, HTakayasu Arteritis, IEAcute Aortic Dissection +9 more
Rule out:SHAortic Stenosis, NHTakayasu Arteritis, IEAcute Aortic Dissection +9 more

Related Systems / Regions

CardiovascularRespiratory

Related Diagnoses

Asthma ExacerbationCardiac TamponadeChronic Obstructive Pulmonary Disease ExacerbationMassive Pulmonary EmbolismTension Pneumothorax

Related Chief Complaints

Chest PainChest PressureChest TightnessChest TraumaCold ExtremitiesConfusionCoughCough Productive of SputumCoughing Up BloodDifficulty Speaking in Full SentencesDizziness on StandingExertional DyspneaFaintingFatigueIncreased SputumLeg SwellingLightheadednessLow Blood PressurePain Worse with BreathingPallorPalpitationsPleuritic Chest PainRapid BreathingRib PainShortness of BreathSyncopeWeaknessWheezingWorsening Cough

References

  • Roy CL, Minor MA, Brookhart MA, Choudhry NK. Does this patient with a pericardial effusion have cardiac tamponade? JAMA. 2007;297(16):1810-1818. doi:10.1001/jama.297.16.1810. PMID: 17456823.
  • Rayner J, Trespalacios F, Machan J, Potluri V, Brown G, Quattrucci LM, Jay GD. Continuous noninvasive measurement of pulsus paradoxus complements medical decision making in assessment of acute asthma severity. Chest. 2006 Sep;130(3):754-765. doi:10.1378/chest.130.3.754. PMID: 16963672. Arnold DH, Jenkins CA, Hartert TV. Noninvasive assessment of asthma severity using pulse oximeter plethysmograph estimate of pulsus paradoxus physiology. BMC Pulm Med. 2010;10:17. doi:10.1186/1471-2466-10-17. PMID: 20350320.
  • Kussmaul A. Ueber schwielige Mediastino-Pericarditis und den paradoxen Puls. Berl Klin Wochenschr. 1873.

Research last updated September 9, 2026.