Pulsus paradoxus

I will go into detail of pulses paradoxes as I told you with falling blood pressure pulses paradoxes is a very important clue to this condition right now what is pulses paradoxes before really I go to the pulses paradoxes I want to explain a very important physiological concept related with the respiratory cycle and arterial blood pressure and then I will tell what is pulses paradoxes right now let me tell you that I'll draw it here blood pressure you know blood pressure uh if if you put a manometer in my bra artery I hope this is brial or femoral brial okay so brial artery sometimes they forget Anatomy right so breal artery if you put a manometer when heart contract pressure goes up that is systolic and when heart is relaxing uh when left ventricle is relaxing pressure when goes down it is called diastolic blood pressure so let's suppose my blood pressure is ideal even though I don't have many things ideal but I'm happy with my Lifest so what is there that system your blood pressure measurement the systemic arterial blood pressure it fluctuates like this it goes from 82 120 down now what is this this is systolic blood pressure then come diastolic then systolic then diastolic then systolic then diastolic right you understand it very clearly everyone understand now actually during respiratory cycle there's fluctuation in systolic blood pressure you must be knowing systolic blood pressure mainly depend on cardiac output if left ventricle is producing more cardiac output if left ventricle is producing more cardiac output systolic blood pressure will go up for example if my left heart more strongly contract right systolic blood pressure may go up right or if my left heart contract very weak then systolic blood pressure will be less than normal so what I'm saying the systolic blood pressure depend on on the performance of the left ventricle systolic arterial blood pressure this is your left ventricle right this is the valve now let me tell you what really happens during respiratory cycle if there are changes basic concept if there are changes in left ventricular output there will be changes in which pressure systolic blood pressure is that clear if there are changes in cardiac output of left ventricle there will be changes in systolic blood pressure now we see during respiratory cycle what really happens this is your chest right diaphragm here lies your uh right heart and let's pose here is your left heart right okay let me make the septum more clearly this is left heart okay this is your right heart right now listen actually normally pericardium which is around it is there it is not it is filled with 30 to 50 ml uh fluid and not interfering with dynamics of the heart right and when the inspiration occur what happen first I will talk about when inspiration occur what happens when inspiration occur you know lungs are shrinking or expanding now let's suppose this patient is undergoing inspiratory process so naturally chest wall is expanding diaphragm is going down and intrac pressure is becoming more negative intrathoracic pressure is becoming more negative so that the air can be sucked in the purpose of when diaphragm goes down and chest wall expand inter posteriorly and side to side laterally what happen intrathoracic pressure becomes negative when there is INTC pressure become more negative it sucks the air in it sucks the air and that is what we call inspiration that is what we call inspiration is it right but with that it also suck the systemic Venus blood chest cavity the Venus return from here and Venus return coming from other spe V and V it also become faster again listen during inspiration right chest is expanding thoracic cavity is expanding pressure intra thoracic pressure become negative as air is pulled in enlarging cavity and increased more negative inic pressure also pull the Venus blood from spirova and also Venus blood from Ina so Venus return to the right Heart during inspiration is less or more more is it clear to everyone so Venus return to the right Heart during inspiration becomes more so when there is more blood coming here so that will lead to what larger M of right ventricle it is slightly overfilled when right ventricle is slightly overfilled it will expand in all Dimensions right ventricle will expand in all Direction during inspiration it will expand in these directions free wall will expand as well as higher amount of blood will not only push these walls it will also push the septum also push the septum so during aspiration not only this extra amount of fluid which is accumulating here not only free wall move outward this free wall this will move outward this septum interocular septum is pushed towards the left so but this pushes very slight suppose this is the septum during inspiration it becomes slightly not very sarly slightly deflected to the left so during this aration due to right over right sided overfilling there's slight deflection to the left side so filling to left side will become slightly less this is one reason why during inspiration Left sided heart is slightly underfilled there's another reason why left side is underfilled during inspiration during inspiration lungs are expanding during expiration inspiration lungs are expanding when lungs are expanding the pulmonary circulation is compliant stretchable so when lungs are expanding not only air pockets expand but also vascul or pulmonary vascul also expand so capacity of pulmonary vascul during inspiration become more or less more so it become more capacity so it try to hold the blood during inspiration so blood from the lungs going to the left side of heart will be less or more less yes you understanding so during inspiration two things happen one thing is there is negative intrac pressure pull more blood to the right side of the heart and right ventricle over filling slightly push the septum to the left and that make the left slightly underfilled second reason is that left side of the heart is receiving the blood coming from pulmonary circulation and as lungs are expanding pulmonary circulation is compliant ponary circulation expand and Venus return to the left heart become less of course when Venus return to left heart is less and also septum is slightly deflected there so this will be overfilled left side or underfill under yes so during inspiration right overfill and left underfills but still this can expand there is very slight movement of septum because expansion can occur in this direction and also in this direction now but in normal person right now when you go inspiration left side is underfill of course indolic volume is less what will happen androlic pressure is less myocardial stretch on the left ventricle is less contractility is less stroke volume is less cardiac output is less and systolic blood pressure slightly drop this is physiological drop this is physiological a normal person with normal respiratory right healthy person during every inspiration left rle become slightly underfilled and due to that reason cardiac output become slightly less and systolic blood pressure become slightly down during yes during inspiration and reverse will occur during expiration expiration so we can say let's suppose this is inspiration right okay let's start the cycle with inspiration and let's start with expiration because it will become easier to explain in expiration opposite occur what will happen during expiration chest cavity is becoming smaller intrac pressure is less negative right what will happen that cable blood will be pulled less efficiently so Venus return during expiration Venus return to right side is less and because lungs are being squeezed during expiration Venus return to left side is more and cardiac output during expiration becomes more and systolic blood pressure goes up now if you very carefully check the blood pressure during let's suppose this is 80 and this is 120 uh systolic blood pressure during expiration is suppose if it is 8120 during inspiration it will fall right during inspiration it will fall and in expiration again it will go up and then again inspiration it will fall and then expiration it will go up and then in Inspiration it will fall now uh this fall this inspiratory fall this inspiratory fall during inspiration this inspiratory fall of systolic blood pressure do right inspiratory fall of systolic blood pressure if it is this fall is less than 10 mm of mercury it is normal for example uh blood pressure during expiration is 120 by 80 and blood pressure during inspiration is suppose 114 by 80 how much is the difference six so this is normal so normal inspire drop in systolic blood pressure should not be more than 10 mm of mercury is that right pardon can you say it more loudly any difference blood pressure duration I will not talk about that later but if you really want to know what is the difference in diastolic the reason being during inspiration sympathetic slightly overflow occur a little teic cardia is there and arterials construct so diastolic may go slightly change but right now in explaining of pulses paradoxes I will focus on systolic blood pressure so what we have learned up to now during expiration systolic blood pressure goes up and during aspiration systolic blood pressure come down in normal person and this difference should be less than 10 mm of mercury right then it is normal now what is pulses paradoxes actually listen what is pulses paradoxes pulses paradoxes is a condition in which inspiratory drop in systolic blood pressure is more than 10 mm of M again repeat I will repeat what is pulses paradoxes or paradoxical pulse paradoxical pulse is a situation in which in during inspiration systolic blood pressure drop or decrease more than 10 mm of M then we say there is pulses paradoxes even though or another way to uh uh mention it is that pulses paradoxes a condition in which normal physiological drop in systolic blood pressure is exaggerated normal physiological drop in systolic blood pressure is exaggerated beyond the normal limit am I clear now so example classical example of this can be let's suppose this is another person in which systolic blood pressure is going like this normal tracing is going like this but here it become like this here it was 120 by 80 during expiration and if there is pulses paradoxes I will explain why pulses paradoxes develop just in 2 minutes but first listen what is pulses paradx pulses paradoxes condition that during inspiration the drop which is supposed to be less than 10 mm it is tooo much a drop rather than here it was normal person I'm just giving example it was 120 and it was 114 or 110 then it is normal but if this is 120 and this is let's suppose it is 100 systolic blood pressure right in this case we will say the systolic blood uh pressure total blood pressure during the what is this expiration it is 120 by 80 and maybe during inspiration it has become 100 by 80 pulse volume has become less sometimes it become so less that pulse is very weak peripheral pulses become very weak or rarely they may be absent you're understanding during inspiration but pulse should appear during expiration if it is absent all the time mother story right am I clear yes sir so now what we have learned up to now only we have learned one thing what is pulses paradoxes pulses paradoxes is a condition in which normal physiological inspiratory drop in systolic blood pressure is exaggerated and it is more than 10 mm of Mary am I clear now pulses paradoxes is one of the important clue towards the what card tempate even when some patient come with acute pericarditis and a fusion even if cardiac tonate is not there you repeatedly check the patient pulses check the blood pressure and jvp and heart sounds and if jvp start rising and pulses paradoxes appear with hypotension you have to think of cardiac temperary

Channel: Dr. Najeeb Lectures

Views: 325,711

Keywords: paradoxic pulse, paradoxical pulse, dr najeeb, dr najeeb lectures, medical lectures, pulsus paradoxus, pulsus paradoxus measurement, pulsus paradoxus examination, pulsus paradoxus causes, pulsus paradoxus how to measure, pulsus paradoxus mechanism, pulsus paradoxus treatment, pulsus paradoxus definition, pulsus paradoxus in cardiac tamponade, cardiac tamponade, pulsus paradoxus pathophysiology, pulsus paradoxus dr najeeb, pulsus paradoxus lecture, pulsus, paradoxus, usmle

Id: 1A7prCrz0Xc

Length: 16min 23sec (983 seconds)

Published: Sun Jul 31 2016