Reverse pulsus paradoxus

Reverse pulsus paradoxus is an expiratory fall in pulse volume, the opposite of pulsus paradoxus. The classical causes of reverse pulsus paradoxus described are [1]:

  1. Isorhythmic atrioventricular (AV) dissociation
  2. Hypertrophic obstructive cardiomyopathy
  3. Intermittent positive pressure ventilation

During intermittent positive pressure ventilation the swings in intrathoracic pressure is opposite to that of normal breathing. Hence the inspiratory blood pressure is higher than the expiratory blood pressure [2].

In case of isorhythmic AV dissociation, inspiratory increase in sinus rate results in sinus rhythm dominating over AV dissociation. In sinus rhythm there is AV synchrony and hence a higher pulse volume, compare to AV dyssynchrony in expiration.


  1. Massumi RA, Mason DT, Vera Z, Zelis R, Otero J, Amsterdam EA. Reversed pulsus paradoxus. N Engl J Med. 1973 Dec 13;289(24):1272-5.
  2. Wong FW. Pulsus paradoxus in ventilated and non-ventilated patients. Dynamics. 2007 Fall;18(3):16-8.