Wide pulse pressure
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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
- 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
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
- 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