Unequal pulses

Unequal pulses

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A difference in blood pressure between arms or between the arms and legs. Examination of the vascular system is imperative. Unequal pulses can be indicative of an underlying disease.

Differential Diagnosis

In alphabetical order.

• Aortic Aneurysm
• Aortic Dissection
• Aortic isthmus stenosis (arms & legs)
• Aortic stenosis
• Atherosclerosis
• Coarctation of the aorta
• Compartment Syndrome
• Hemiplegia
• Patent ductus arteriosus
• Stenosis of the brachiocephalic trunk
• Subclavian-Steal Syndrome
• Subclavian artery abnormality/stenosis
• Syphilis
• Takayasu's Arteritis(pulseless disease)
• Thoracic aortic aneurysm
• Thoracic Outlet Syndrome
• Vasculitis

Diagnosis

Aortic aneurysm

• Pulsatile abdominal mass

Atherosclerosis

• Atrophic changes and dependent rubor

Coarctation of the aorta

• continuous murmur
• asymmetric blood pressure

Aortic dissection

• hypertension
• diastolic murmur of aortic insufficency
• left pleural effusion

Peripheral heart disease

• ABI of systolic pressure <0.9

Severe ischemia

• <0.5 ABI of systolic pressure

Chest X Ray

• potentially reveals

• widened mediastinum
• aortic dissection

• pleural effusion
• tracheal deviation

• "rib notching"

• intercostal artery collateral channels in coarctation of the aorta.

MRA and CT

• used to diagnose Takayasu's arteritis, aortic aneurysm, peripheral artery disease
• MRA, trasesophageal echocardiogram, CT -> aortic dissection

Other Imaging Findings

• Angiography

• Takayasu's arteritis
• PAD
• Aortic dissection
• Coarctation of the aorta

Acknowledgements

The content on this page was first contributed by Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

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