Wide pulse pressure: Difference between revisions
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{{SI}} | {{SI}} | ||
{{CMG}} | {{CMG}} | ||
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*[[Thyrotoxicosis]] | *[[Thyrotoxicosis]] | ||
==Physical Examination== | ==Diagnosis== | ||
=== Heart === | ===Physical Examination=== | ||
==== Heart ==== | |||
''Chronic Aortic Regurgitation'' | ''Chronic Aortic Regurgitation'' | ||
*[[Diastolic murmur]] | *[[Diastolic murmur]] | ||
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:*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]]: To rule out anemia | *[[CBC]]: To rule out anemia | ||
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== Treatment == | == Treatment == | ||
===Medical Therapy=== | |||
*Treat underlying causes | *Treat underlying causes | ||
:*[[anemia]] | :*[[anemia]] | ||
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:*regulate cranial pressure | :*regulate cranial pressure | ||
== | ==== 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]] | ||
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*[[vasodilator]]s | *[[vasodilator]]s | ||
== Surgery | === Surgery === | ||
=== Indications for Surgery === | === Indications for Surgery === | ||
Revision as of 19:41, 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
Diagnosis
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
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
- Beta-blockers
- PTU
Chronic aortic regurgitation
- diuretics
- pressors
- vasodilators
Surgery
Indications for Surgery
- Emergency surgery
Chronic aortic regurgitation
- Aortic valve replacement
- Commonly in patients with low EF
- thyroidectomy