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Pulsus Paradoxus, Cardiac Tamponade, and the Pericardial 'Window'

Arch Intern Med. 1990;150(11):2409-2412. doi:10.1001/archinte.1990.00390220137035.
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To the Editor.—Leventhal and colleagues' report1 concerning nonspecificity of antinuclear antibody in pericardial fluid was very helpful for those of us who sometimes puzzle over this test. Although the authors make their main point quite nicely, their case was even more informative than they may have realized. Among many interesting aspects was the conversion in a very short time from a tamponading pericardial effusion to "dry" constrictive pericarditis, not discussed by the authors. I have seen the same phenomenon in malignant pericardial disease within approximately the same period—4 weeks. Their patient's S3 gallop was typical for constriction, and the pathologic specimen leaves little doubt. Although jugular venous distention was noted, no mention was made of Kussmaul's sign, which might well have been present (although necessarily absent in the preceding tamponade). The "pulsus paradoxus" of 8 mm Hg is not really within the definition of the term pulsus paradoxus


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