Wide pulse pressure
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
Life Threatening Causes
Common Causes
- Anemia
- Anxiety
- Aortic dissection
- Aortic regurgitation
- Arteriovenous fistula
- Atherosclerosis
- Complete heart block
- Endocarditis
- Fever
- Isolated systolic hypertension
- Patent ductus arteriosus
- Raised intracranial pressure
- Thyrotoxicosis
Causes by Organ System
| Cardiovascular | No underlying causes |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | No underlying causes |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | No underlying causes |
| Musculoskeletal/Orthopedic | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional/Metabolic | No underlying causes |
| Obstetric/Gynecologic | No underlying causes |
| Oncologic | No underlying causes |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | No underlying causes |
| Psychiatric | No underlying causes |
| 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 | No underlying causes |
Causes in Alphabetical Order
- Anemia
- Anxiety
- Aortic dissection
- Aortic regurgitation
- Arteriovenous fistula
- Atherosclerosis
- Complete heart block
- Elderly
- Endocarditis
- Fever
- Isolated systolic hypertension
- Patent ductus arteriosus
- Pregnancy
- Raised intracranial pressure
- Sinus bradycardia
- Thyrotoxicosis
- Wet beriberi
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 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
- 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