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Palpable Pulsus Paradoxus in Primary Care Clinic

  • Scott L. Hagan
    Correspondence
    Requests for reprints should be addressed to Scott L. Hagan, MD, Veterans Affairs (VA) Puget Sound Health Care System, 4522 49th Ave SW, Seattle, WA, 98116.
    Affiliations
    Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Wash

    Department of Medicine, Division of General Internal Medicine
    Search for articles by this author
  • Stephen D. Farris
    Affiliations
    Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Wash

    Department of Medicine, Division of Cardiology, University of Washington, Seattle
    Search for articles by this author
Published:January 11, 2021DOI:https://doi.org/10.1016/j.amjmed.2020.12.021
      A 52-year-old man with recently diagnosed metastatic carcinoma of unknown primary site presented to a primary care clinic for evaluation of lightheadedness. Two days prior, the patient presented to the Emergency Department after an episode of near syncope while standing. Initially hypotensive, he received a 1-L bolus of normal saline, his blood pressure improved, and he no longer felt lightheaded. His symptoms were presumed to be secondary to poor oral intake, and he was discharged home. The lightheadedness returned 24 hours later, and he came to his primary care office 2 days later for evaluation.
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