The History of Pulsus Paradoxus

Given our recent post and Stanford 25 session on pulsus paradoxus, we wanted to continue the theme with a historical perspective:

According to this article, cardiac tamponade was first noted by the Cornish physician Richard Lower in the following quote: “The envelope becomes filled in hydrops of the heart; the walls of the heart are compressed by the fluid settling everywhere so that the heart cannot dilate sufficiently to receive the blood; then the pulse becomes exceedingly small, until finally it becomes utterly suppressed by the great inundation of fluid whence succeed syncope and death itself.”

In 1761 Joseph Auenbrugger described physical signs of a pericardial effusion: protrusion of the sternum, bulging of the epigastrium and decreased resonance in Traube’s space. In 1873 the German physician Adolf Kussmaul described pulsus paradoxus in three patients when he noted their pulse disappeared completely during inspiration while their heartbeat remain regular. Finally another German physician, Edmund Rose, in 1884 coined the term cardiac tamponade in a description of fatal heart wounds which caused death by constricting the filling of the heart through compression. It is interesting to note that it is the same Kussmaul of Kussmaul’s sign who first noted pulsus paradoxus, while Kussmaul’s sign (increase of lack of decrease of the JVP during inspiration) is usually absent in cardiac tamponade (although can be seen occasionally).

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