# The patient's cardiac exam reveals a ______ pulse, where the pulse amplitude decreases during inspiration, indicating pericardial tamponade.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=168407  
> language: ko  
> subject: Diseases of the circulatory system

## 문제

The patient's cardiac exam reveals a ______ pulse, where the pulse amplitude decreases during inspiration, indicating pericardial tamponade.

## 보기

1. paradoxical **✔ 정답**
2. alternating
3. bounding
4. thready
5. water-hammer

**정답: 1**

## 해설

A paradoxical pulse, where systolic blood pressure falls abnormally (>10 mmHg) during inspiration, is a key finding in cardiac tamponade. This occurs due to increased negative intrathoracic pressure during inspiration, which further impairs left ventricular filling in the setting of tamponade.

## 임상 시나리오

• Paradoxical pulse definition: Exaggerated decrease in systolic blood pressure during inspiration (>10 mmHg drop)

• Key signs of cardiac tamponade:
- Beck's triad: hypotension, distended neck veins, muffled heart sounds
- Pulsus paradoxus
- Tachycardia
- Elevated JVP
- Electrical alternans on ECG

• Pathophysiology of cardiac tamponade:
- Fluid accumulation in pericardial space
- Restricted cardiac filling
- Decreased stroke volume
- Compromised cardiac output

• Common causes:
- Pericarditis
- Trauma
- Malignancy
- Post-cardiac surgery
- Uremia
- Infection

• Treatment options:
- Pericardiocentesis
- Surgical pericardiectomy
- Volume expansion
- Treatment of underlying cause

## 핵심 개념

- **paradoxical** — A condition where something behaves in a way that contradicts normal physiological patterns, specifically referring to an abnormal decrease in systolic blood pressure during inspiration
- **alternating** — A pulse pattern that regularly varies in strength between beats, often associated with certain cardiac conditions
- **bounding** — A strong, forceful pulse that can be easily felt and is often associated with high cardiac output states
- **thready** — A weak, thin pulse that is difficult to palpate, often indicating poor peripheral perfusion
- **water-hammer** — A forceful, rapidly collapsing pulse characteristic of aortic regurgitation, also known as Corrigan's pulse

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