The ultimate pulsus paradoxus: failure of aortic valve opening with inspiration.

摘要

A 45-year-old female with a history of breast cancer presented with dyspnoea and fatigue. On physical examination, the radial pulse disappeared with inspiration. Transthoracic echocar-diography demonstrated a large pericardial effusion (PE) (see Supplementary data online, Videos S1) with features of cardiac tamponade. Right atrial compression (see Supplementary data online, Videos S2) and right ventricular (RV) diastolic collapse (see Supplementary data online, Videos S3) were present with masses noted on the visceral pericardium suggestive of metastasis (see Supplementary data online, Videos S4). M-mode echocardiography showed an increase in the RV size, decrease in the left ventricular (LV) size and marked decrease in mitral valve opening with inspiration (Panel A). The aortic valve (AV) failed to open with inspiration (Panel 8) and this was associated with the absence of flow in the descending thoracic aorta (Panel C). Transmitral Doppler demonstrated marked inspiratory decrease of flow velocity and duration (Panel D) with opposite findings across the tricuspid valve (Panel E).