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{{Infobox_Disease |
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{{SI}}
{{SI}}
{{CMG}}
{{CMG}}; {{AE}} {{Ochuko}}


==Overview==  
==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.
*The difference between systolic and dyastolic blood pressure is called pulse pressure.
*A blood pressure difference greater than 60 - 70 mmHg is considered wide pulse pressure.
*Frequently resulting in an increase in stroke volume.


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


In alphabetical order <ref>Sailer, Christian, Wasner, Susanne.  Differential Diagnosis Pocket.  Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref>  <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
*[[Aortic dissection]]
*[[Atrial fibrillation]]
*[[Dengue fever]]
*[[Endocarditis]]
*[[ST elevation myocardial infarction]]


*[[Aortic Dissection]]  
===Common Causes===
*[[Anemia]]
*[[Anxiety]]
*[[Aortic dissection]]
*[[Aortic regurgitation]]
*[[Arteriovenous fistula]]
*[[Atherosclerosis]]
*[[Atherosclerosis]]
:*Due to the hardening of arteries with age, there is an increased systolic blood pressure resulting in a higher pulse pressure.
*[[Complete heart block]]
*[[Chronic Aortic Regurgitation]]
:*Wide pulse pressure is not a direct result of [[Aortic regurgitation]].
:*Potentially leads to:
::*[[Chronic Heart Failure]]
::*[[Syncope]]
::*[[Angina]]
:*Causes
::*[[Marfan's Syndrome]]
::*idiopathic root dilation
::*[[Rheumatic Heart Disease]]
*Complete heart block
:*Resultant of [[myocardial infarction]] or [[coronary artery disease]]
*[[Endocarditis]]
*[[Endocarditis]]
*Increased [[cardiac output]] states
*[[Fever]]
:*[[Anemia]]  
*[[systolic hypertension|Isolated systolic hypertension]]
:*[[Anxiety]]  
*[[Patent ductus arteriosus]]
:*[[Fever]]
*[[Raised intracranial pressure]]
:*[[Pregnancy]]
*[[Thyrotoxicosis]]
*Increased intracranial pressure
 
===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" | [[Abdominal aortic aneurysm]], [[aortic dissection]], [[aortic insufficiency]], [[aortic regurgitation]], [[arteriosclerosis]], [[arteriovenous fistula]], [[artificial pacemaker]], [[atherosclerosis]], [[atrial fibrillation]], [[cardiac arrest]], [[complete heart block]], [[endocarditis]], [[bradycardia|extreme bradycardia]], [[heart murmur]], [[high output cardiac failure]], [[hyperkinetic heart syndrome]], [[hypertension]], [[infective endocarditis]], [[systolic hypertension|isolated systolic hypertension]], [[mitral valve prolapse]], [[Monckeberg's arteriosclerosis]], [[patent ductus arteriosus]], [[pulmonic regurgitation]], [[sinus bradycardia]], [[ST elevation myocardial infarction]], [[stroke]], [[supraventricular tachycardia]], [[third degree AV block]], [[waterhammer pulse]], [[wet beriberi]]
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| [[Ethylene]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Benzodiazepine withdrawal syndrome]], [[cocaine]], [[maprotiline]], [[nicotine]], [[oxybutynin]], [[oxygen therapy]], [[phenelzine]], [[vasodilators]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Diabetes mellitus]], [[Graves disease]], [[growth hormone]], [[polycystic ovary syndrome]], [[thyrotoxicosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Genetic]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Anemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Anesthesia]], [[laser ablation]], [[mechanical ventilation]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Dengue fever]], [[infective endocarditis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Raised intracranial pressure]], [[stroke]], [[subarachnoid hemorrhage]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Wet beriberi]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Polycystic ovary syndrome]], [[pregnancy]]
|-
|-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"| [[Anxiety]]
|-
|-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"| [[Elderly]], [[fever]], [[mechanical ventilation]], [[pyrexia]]
|-
|}
 
===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]]
*[[Patent ductus arteriosus]]
:*Murmmur through systole and diastole
*[[Phenelzine]]
:*Bounding impulses
*[[Polycystic ovary syndrome]]
*[[Sinus Bradycardia]]
*[[Pregnancy]]
*Systemic AV Fistula
*[[Pulmonic regurgitation]]
*[[Pyrexia]]
*[[Raised intracranial pressure]]
*[[Sinus bradycardia]]
*[[ST elevation myocardial infarction]]
*[[Stroke]]
*[[Subarachnoid hemorrhage]]  
*[[Supraventricular tachycardia]]
*[[Third degree AV block]]
*[[Thyrotoxicosis]]
*[[Thyrotoxicosis]]
:*sympoms include
*[[Vasodilators]]
::*[[nervousness]]
*[[Waterhammer pulse]]  
::*[[sweating]]
*[[Wet beriberi]]
::*heat intolerance
{{col-end}}
::*[[tachycardia]]
::*[[weight loss]]
:*Potential thyroid nodule


=== Heart ===
==Diagnosis==
===Physical Examination===
==== Heart ====
''Chronic Aortic Regurgitation''
''Chronic Aortic Regurgitation''
*[[Diastolic murmur]]
*[[Diastolic murmur]]
Line 70: Line 218:
:*Systolic BP of lower limbs >20mmHg than Systolic BP in arms
:*Systolic BP of lower limbs >20mmHg than Systolic BP in arms


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


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


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


=== MRI and CT ===  
=== MRI and CT ===  
Line 98: Line 244:


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


== Treatment ==
== Treatment ==
===Medical Therapy===
*Treat underlying causes
*Treat underlying causes
:*[[anemia]]
:*[[Anemia]]
:*chronic disease
:*Chronic disease
:*[[fever]]
:*[[Fever]]
:*[[hypothyroidism]]
:*[[Hypothyroidism]]
:*regulate cranial pressure
:*Regulate cranial pressure
 
== Pharmacotherapy ==


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


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


== Surgery and Device Based Therapy ==  
=== Surgery ===  


=== Indications for Surgery ===  
=== Indications for Surgery ===  
Line 135: Line 281:
:*Commonly in patients with low EF
:*Commonly in patients with low EF
''[[Hyperthyroidism]]
''[[Hyperthyroidism]]
:*thyroidectomy
:*[[Thyroidectomy]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{SIB}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}


[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Medical signs]]
[[Category:Medical signs]]
[[Category:Signs and symptoms]]
[[Category:Signs and symptoms]]
[[Category:Crowdiagnosis]]
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Latest revision as of 18:43, 4 December 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

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.

Common Causes

Causes by Organ System

Cardiovascular Abdominal aortic aneurysm, aortic dissection, aortic insufficiency, aortic regurgitation, arteriosclerosis, arteriovenous fistula, artificial pacemaker, atherosclerosis, atrial fibrillation, cardiac arrest, complete heart block, endocarditis, extreme bradycardia, heart murmur, high output cardiac failure, hyperkinetic heart syndrome, hypertension, infective endocarditis, isolated systolic hypertension, mitral valve prolapse, Monckeberg's arteriosclerosis, patent ductus arteriosus, pulmonic regurgitation, sinus bradycardia, ST elevation myocardial infarction, stroke, supraventricular tachycardia, third degree AV block, waterhammer pulse, wet beriberi
Chemical/Poisoning Ethylene
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Benzodiazepine withdrawal syndrome, cocaine, maprotiline, nicotine, oxybutynin, oxygen therapy, phenelzine, vasodilators
Ear Nose Throat No underlying causes
Endocrine Diabetes mellitus, Graves disease, growth hormone, polycystic ovary syndrome, thyrotoxicosis
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic Genetic
Hematologic Anemia
Iatrogenic Anesthesia, laser ablation, mechanical ventilation
Infectious Disease Dengue fever, infective endocarditis
Musculoskeletal/Orthopedic No underlying causes
Neurologic Raised intracranial pressure, stroke, subarachnoid hemorrhage
Nutritional/Metabolic Wet beriberi
Obstetric/Gynecologic Polycystic ovary syndrome, pregnancy
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Anxiety
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Elderly, fever, mechanical ventilation, pyrexia

Causes in Alphabetical Order

Diagnosis

Physical Examination

Heart

Chronic Aortic Regurgitation

  • Rapid rise and fall
  • Systolic BP of lower limbs >20mmHg than Systolic BP in arms

Other

Chronic Aortic Regurgitation

  • head bobs back and forth with each heartbeat

Laboratory Findings

Suggested Labs

Chest X Ray

MRI and CT

Echocardiography or Ultrasound

Other Imaging Findings

Treatment

Medical Therapy

  • Treat underlying causes

Acute Pharmacotherapy

Chronic Pharmacotherapies

Hyperthyroidism

Chronic aortic regurgitation

Surgery

Indications for Surgery

Aortic dissection

  • Emergency surgery

Chronic aortic regurgitation

  • Aortic valve replacement
  • Commonly in patients with low EF

Hyperthyroidism

References


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