Is a decrease in blood pressure when breathing a sign of a serious illness? (Pulsus Paradoxus)

Have you ever heard a doctor, while checking your blood pressure, say something like, "Take a deep breath in... now breathe out..."? Sometimes we think it's just a saying. But in reality, sometimes the doctor is checking to see if there is a specific change in your blood pressure with your breathing pattern. There is a very important reason for this. Today we are going to talk about one such special medical sign, which is 'Pulsus Paradoxus'. This name may sound a bit complicated when you hear it, but let's explain it simply.

What exactly is Pulsus Paradoxus?

Simply put, Pulsus Paradoxus is when your blood pressure, especially the top number (systolic pressure), drops significantly more than expected when you inhale.

Now you might be thinking, "So what's so strange about that?" The paradox here is that normally, when a healthy person inhales, their blood pressure should only increase slightly or not change much. But in this case, the exact opposite happens. That is, the pressure drops unexpectedly. This is not a disease, but a very important sign that tells us that there is something wrong inside your body, especially in the heart or lungs.

Think about it, our heart is the one that pumps blood throughout our body. When we breathe, there are changes in the pressure in our chest. These changes have a small effect on how well the heart fills with blood. However, if the heart is unable to expand properly due to a medical condition, or if there is a lot of pressure around the heart, the amount of blood that enters the heart when we breathe decreases significantly . As a result, the amount of blood that the heart pumps to the body also decreases, which is why we see a sudden drop in blood pressure.

How does a doctor measure this?

This is not something you can measure with a digital pressure meter at home. Because this is something that needs to be measured very carefully. For this, a doctor usually uses a manually pumped pressure cuff and a stethoscope (manual blood pressure cuff).

Here's how to do it:

1. First, the doctor will place a pressure cuff on your arm and inflate it until you can no longer hear your pulse.

2. Then, while deflating the cuff very quickly (at a rate of about 2 millimeters of mercury per second), the stethoscope is used to find the first place where the pulse sound is heard. At this point, the sound is heard when you exhale (exhaling). That value is recorded.

3. Next, as you inflate the cuff a little more, you will find the point where you can still hear the pulse as you breathe in and out . You will also record that value.

4. Finally, the difference between these two recorded upper pressure values ​​is calculated.

What are the main causes of Pulsus Paradoxus?

If you see the sign Pulsus Paradoxus, it means that something is preventing the heart from working properly. There can be several reasons for this.

The main and most common cause is the accumulation of fluid around the heart, which causes cardiac tamponade. Let us explain this a little more. Our heart is located inside a thin sac-like covering called the 'pericardium'. This usually contains a very small amount of fluid to protect and lubricate the heart. However, if due to some medical condition, too much fluid (like water) accumulates inside this sac, it is called Pericardial Effusion . If this fluid increases, the pericardial sac stretches, and eventually causes cardiac tamponade . This is a serious condition that requires emergency medical treatment. This is the most common cause of Pulsus Paradoxus.

Apart from this, there are several other possible causes of Pulsus Paradoxus in the table below.

How is this treated?

The most important thing we all need to understand here is that there is no direct treatment for the symptom called Pulsus Paradoxus. Because it is not a disease. It is like a warning light that comes on on the dashboard when there is a problem with the engine of a car. What we are doing is not turning the light off and on, but fixing the problem in the engine.

The treatment method is determined by the cause.

• If the cause is Cardiac Tamponade , emergency treatment involves removing the extra fluid around the heart using a syringe and needle (pericardiocentesis). Surgery may also be necessary.
• If the cause is severe asthma , medications and nebulizer treatments are provided to control the asthma.
• If the cause is pneumothorax (a collapsed lung), a tube is inserted into the chest to remove the excess air.
• In cases like Constrictive Pericarditis , the thickened pericardium may need to be surgically removed.

This way, the doctor will first find out the exact cause and give you the best treatment that suits it. Therefore, if your doctor tells you about a symptom like this, it is very important not to be afraid of it and to fully cooperate with the tests and treatment that are being done to find the cause.

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