Reversed Pulsus Paradoxus in Right Ventricular Failure.

Area of Science:

• Cardiology
• Physiology

Background:

• Reversed pulsus paradoxus (RPP) is a rare phenomenon characterized by an increase in peak systolic arterial pressure during inspiration.
• It has been previously described in specific conditions like idiopathic hypertrophic subaortic stenosis, isorhythmic ventricular rhythm, and left ventricular systolic dysfunction during positive pressure ventilation.

Observation:

• This case report details RPP in a patient presenting with a large pericardial effusion, right ventricular failure, and pulmonary arterial hypertension.
• Notably, echocardiography did not reveal features of cardiac tamponade despite significant right ventricular hypertrophy and pulmonary hypertension.

Findings:

• The study observed the RPP phenomenon in the context of pericardial effusion and right heart failure.
• Positive pressure ventilation can augment left ventricular preload and emptying, potentially explaining the inspiratory rise in systolic pressure.

Implications:

• The case highlights the importance of recognizing RPP in complex cardiac conditions beyond its typical associations.
• It also underscores the potential for acute congestive heart failure following pericardiocentesis in such patients, necessitating careful monitoring.