Wide pulse pressure: Difference between revisions
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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. | 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== | ||
*[[Aortic Dissection]] | *[[Aortic Dissection]] | ||
| Line 22: | Line 20: | ||
*Increased [[intracranial pressure]] | *Increased [[intracranial pressure]] | ||
*[[Patent ductus arteriosus]] | *[[Patent ductus arteriosus]] | ||
:* | :*Murmur through systole and diastole | ||
:*Bounding impulses | :*Bounding impulses | ||
*[[Sinus Bradycardia]] | *[[Sinus Bradycardia]] | ||
Revision as of 19:34, 12 October 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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
- Due to the hardening of arteries with age, there is an increased systolic blood pressure resulting in a higher pulse pressure.
- Aortic regurgitation
- Complete heart block
- Endocarditis
- Increased cardiac output states
- Murmur through systole and diastole
- Bounding impulses
- Sinus Bradycardia
- Systemic AV Fistula
- Thyrotoxicosis
Physical Examination
Heart
Chronic Aortic Regurgitation
- Rapid rise and fall
- Systolic BP of lower limbs >20mmHg than Systolic BP in arms
Other
- head bobs back and forth with each heartbeat
Laboratory Findings
Suggested Labs
- CBC: To rule out anemia
- TSH: To rule out thyrotoxicosis
- Blood Cultures: 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 suspect of atherosclerosis
- CAD risk stratification measurement
- cholesterol screening
- stress test
- cardiac catheterization
Treatment
- Treat underlying causes
- anemia
- chronic disease
- fever
- hypothyroidism
- regulate cranial pressure
Pharmacotherapy
Acute Pharmacotherapies
- Emergency blood cultures and IV antibiotic for endocarditis
Chronic Pharmacotherapies
- Beta-blockers
- PTU
Chronic aortic regurgitation
- diuretics
- pressors
- vasodilators
Surgery and Device Based Therapy
Indications for Surgery
- Emergency surgery
Chronic aortic regurgitation
- Aortic valve replacement
- Commonly in patients with low EF
- thyroidectomy