Pulsus Paradoxus in A 30 Year Old Patients with Cardiac Tamponade

Clinical Image

A 30-year-old male with a history of trisomy 21, unrestricted VSD, Eisenmenger's syndrome with pulmonary arterial hypertension presented with increasing shortness of breath. A transthoracic echocardiogram revealed a massive pericardial effusion with resulting cardiac tamponade. An arterial line showed significant drop in his systolic blood pressures during inspiration which is shown in the image below.