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Pulsus paradoxus is not seen in hypertrophic cardiomyopathy. Pulsus paradoxus refers to the fall in systolic pressure by > 10 mmHg with inspiration. It is an exaggeration of the normal response. During inspiration under normal circumstances, the venous returns increase due to the reduced intrathoracic pressure, thereby increasing the right ventricular stroke volume. Consequently, due to ventricular interdependence, the left ventricular stroke volume falls slightly. When the heart is constrained either due to effusion or pericarditis, the left ventricular stroke volume further reduces causing a fall in systolic pressure by >10 mmHg. It is seen in the following conditions: Cardiac tamponade Massive pulmonary embolism Hemorrhagic shock