Physical examination maneuver

Physical Exam

Pulsus Paradoxus

also known as Paradoxical pulse
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Video coming September 2026

How to Perform

Inflate a blood-pressure cuff above systolic pressure, then deflate slowly. Note the pressure at which Korotkoff sounds are first heard (only during expiration) and the pressure at which they are heard throughout the respiratory cycle. A difference greater than 10 mmHg between these two pressures defines pulsus paradoxus.

How to Interpret

Showing 2 of 5 findings

Cardiac Tamponade

Pulsus paradoxus
Rule in
Somewhat helpful
Rule out
Very helpful
Evidence:Limited

Severe Asthma Exacerbation

Pulsus paradoxus
Rule in
Somewhat helpful
Rule out
Somewhat helpful
Evidence:Limited

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. With primary-study reference: Curtiss EI, Reddy PS, Uretsky BF, Cecchetti AA. Pulsus paradoxus: definition and relation to the severity of cardiac tamponade. Am Heart J. 1988;115:391-398.
  • 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. Corroborating: 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.

Related Systems / Regions

CardiovascularRespiratory

Related Bedside Tests

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Oxygen Saturation
aka Pulse oximetry
Rule in:SHPneumonia, IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure +5 more
Rule out:IEChronic Obstructive Pulmonary Disease (COPD) Exacerbation, IEHeart Failure, IEPeripheral Artery Disease +4 more
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Jugular Venous Pressure
Rule in:VHHypovolemia, HHeart Failure, HRight Ventricular Infarction +8 more
Rule out:HRight Ventricular Infarction, SHHypovolemia, SHPulmonary Hypertension +8 more
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Blood Pressure
Rule in:VHAortic Regurgitation, VHVolume Depletion From Significant Blood Loss, HAcute Aortic Dissection +11 more
Rule out:VHVolume Depletion From Significant Blood Loss, HLow-output State (Low Cardiac Index) Within Established Chronic Heart Failure, SHAcute Aortic Dissection +10 more
🎬Video coming Sept 2026
Heart Rate
Rule in:HAtrial Fibrillation, SHHypothyroidism, SHPneumonia +7 more
Rule out:VHAtrial Fibrillation, MHAdverse Short-term Outcome in Confirmed Pulmonary Embolism, IECardiac Tamponade +5 more
🔒Sign in
Cardiac Auscultation
Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy with Obstruction +34 more
Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy with Obstruction, SHAortic Regurgitation +33 more
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Chest Percussion
Rule in:HLarge Pleural Effusion, HPleural Effusion, SHLobar Pneumonia or Consolidation +10 more
Rule out:IEAtelectasis, IEBullous Emphysema, IECOPD with Hyperinflation +8 more