View source for Wide pulse pressure

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{{SI}}
{{CMG}}; {{AE}} {{Ochuko}}

==Overview== 
A wide [[pulse pressure]] is defined as a difference between the [[systolic blood pressure]] and the [[diastolic blood pressure]] that exceeds 60 - 70 mm Hg.

==Causes== 
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. 

*[[Aortic dissection]]
*[[Dengue fever]]
*[[ST elevation myocardial infarction]]

===Common Causes===
*[[Anemia]] 
*[[Anxiety]] 
*[[Aortic dissection]] 
*[[Aortic regurgitation]]
*[[Arteriovenous fistula]]
*[[Atherosclerosis]]
*[[Complete heart block]]
*[[Endocarditis]]
*[[Fever]]
*[[systolic hypertension|Isolated systolic hypertension]]
*[[Patent ductus arteriosus]]
*[[Raised intracranial pressure]]
*[[Thyrotoxicosis]]

===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}



===Causes in Alphabetical Order===
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[Abdominal aortic aneurysm]]
*[[Anemia]]
*[[Anesthesia]] 
*[[Anxiety]]
*[[Aortic dissection]] 
*[[Aortic insufficiency]]
*[[Aortic regurgitation]] 
*[[Arteriosclerosis]] 
*[[Arteriovenous fistula]]
*[[Artificial pacemaker]] 
*[[Atherosclerosis]]
*[[Atrial fibrillation]]
*[[Benzodiazepine withdrawal syndrome]]
*[[Cardiac arrest]]
*[[Cocaine]]
*[[Complete heart block]]
*[[Dengue fever]]
*[[Diabetes mellitus]] 
*[[Elderly]]
*[[Endocarditis]]
*[[Ethylene]]
*[[bradycardia|Extreme bradycardia]]
*[[Fever]]
*[[Genetic]]
*[[Graves disease]] 
*[[Growth hormone]]
*[[Heart murmur]] 
*[[High output cardiac failure]] 
*[[Hyperkinetic heart syndrome]]
{{col-break|width=33%}}
*[[Hypertension]]
*[[Infective endocarditis]]
*[[systolic hypertension|Isolated systolic hypertension]]
*[[Laser ablation]]
*[[Maprotiline]]
*[[Mechanical ventilation]]
*[[Mitral valve prolapse]] 
*[[Monckeberg's arteriosclerosis]]
*[[Nicotine]]
*[[Oxybutynin]] 
*[[Oxygen therapy]]
*[[Patent ductus arteriosus]]
*[[Phenelzine]] 
*[[Polycystic ovary syndrome]]
*[[Pregnancy]]
*[[Pulmonic regurgitation]]
*[[Pyrexia]]
*[[Raised intracranial pressure]]
*[[Sinus bradycardia]]
*[[ST elevation myocardial infarction]]
*[[Stroke]]
*[[Subarachnoid hemorrhage]] 
*[[Supraventricular tachycardia]]
*[[Third degree AV block]]
*[[Thyrotoxicosis]]
*[[Vasodilators]]
*[[Waterhammer pulse]] 
*[[Wet beriberi]]
{{col-end}}

==Diagnosis==
===Physical Examination===
==== Heart ====
''Chronic Aortic Regurgitation''
*[[Diastolic murmur]]
*[[Corrigan pulse]]
:*Rapid rise and fall
*[[Hill's sign]]
:*Systolic BP of lower limbs >20mmHg than Systolic BP in arms

==== Other ====
''[[Chronic Aortic Regurgitation]]''
*[[de Musset's sign]]
:*head bobs back and forth with each heartbeat

=== Laboratory Findings === 
'''Suggested Labs'''
*[[CBC]]: To rule out anemia
*[[TSH]]: To rule out [[thyrotoxicosis]]
*[[Blood culture]]s: To rule out endocarditis
*[[Free T4]]: To rule out [[thyrotoxicosis]]
*[[Free T3]]: To rule out [[thyrotoxicosis]]

=== Chest X Ray === 
*May demonstrate [[aortic dissection]] if there is aortic knob enlargement and [[widened mediastinum]]

=== MRI and CT === 
*CT can indicate [[aortic dissection]]
*MRI can also be used to diagnose [[aortic dissection]]

=== Echocardiography or Ultrasound === 
*Better than [[Aortography]]
*[[Transesophageal echocardiography]] measures [[aortic regurgitation]]
:*detects two additional lumen for diagnosis of [[aortic dissection]]

=== Other Imaging Findings ===
*If there is a suspicion of [[atherosclerosis]];
::*[[CAD]] risk stratification measurement
::*[[Cholesterol]] screening
::*Stress test
::*[[Cardiac catheterization]]

== Treatment ==

===Medical Therapy===
*Treat underlying causes
:*[[Anemia]]
:*Chronic disease
:*[[Fever]]
:*[[Hypothyroidism]]
:*Regulate cranial pressure

==== Acute Pharmacotherapy ==== 
*Emergency blood cultures and IV antibiotic for [[endocarditis]]

==== Chronic Pharmacotherapies ==== 
''[[Hyperthyroidism]]''
*[[Beta-blockers]]
*PTU
''Chronic [[aortic regurgitation]]''
*[[Diuretic]]s
*Pressors
*[[Vasodilator]]s

=== Surgery === 

=== Indications for Surgery === 
''[[Aortic dissection]]''
:*Emergency surgery 
''Chronic [[aortic regurgitation]]''
:*Aortic valve replacement
:*Commonly in patients with low EF
''[[Hyperthyroidism]]
:*[[Thyroidectomy]]

==References==
{{Reflist|2}}

[[Category:Cardiology]]
[[Category:Medical signs]]
[[Category:Signs and symptoms]]
[[Category:Crowdiagnosis]]

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