Wide pulse pressure: Difference between revisions
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:*Due to the hardening of arteries with age, there is an increased systolic blood pressure resulting in a higher pulse pressure. | :*Due to the hardening of arteries with age, there is an increased systolic blood pressure resulting in a higher pulse pressure. | ||
*[[Chronic Aortic Regurgitation]] | *[[Chronic Aortic Regurgitation]] | ||
*[[Complete heart block]] | |||
*[[Endocarditis]] | *[[Endocarditis]] | ||
*Increased [[cardiac output]] states | *Increased [[cardiac output]] states | ||
Line 47: | Line 37: | ||
:*[[Fever]] | :*[[Fever]] | ||
:*[[Pregnancy]] | :*[[Pregnancy]] | ||
*Increased intracranial pressure | *Increased [[intracranial pressure]] | ||
*[[Patent ductus arteriosus]] | *[[Patent ductus arteriosus]] | ||
:*Murmmur through systole and diastole | :*Murmmur through systole and diastole | ||
Line 54: | Line 44: | ||
*Systemic AV Fistula | *Systemic AV Fistula | ||
*[[Thyrotoxicosis]] | *[[Thyrotoxicosis]] | ||
==Physical Examination== | |||
=== Heart === | === Heart === | ||
''Chronic Aortic Regurgitation'' | ''Chronic Aortic Regurgitation'' |
Revision as of 12:22, 15 April 2012
Wide pulse pressure |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
- The difference between systolic and dyastolic blood pressure is called pulse pressure.
- A blood pressure difference greater than 60 - 70 mmHg is considered wide pulse pressure.
- Frequently resulting in an increase in stroke volume.
Differential Diagnosis of Causes of Wide pulse pressure
- Due to the hardening of arteries with age, there is an increased systolic blood pressure resulting in a higher pulse pressure.
- Chronic Aortic Regurgitation
- Complete heart block
- Endocarditis
- Increased cardiac output states
- Murmmur 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
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