Wide pulse pressure: Difference between revisions
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Revision as of 11:58, 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.
- Wide pulse pressure is not a direct result of Aortic regurgitation.
- Potentially leads to:
- Causes
- Marfan's Syndrome
- idiopathic root dilation
- Rheumatic Heart Disease
- Complete heart block
- Resultant of myocardial infarction or coronary artery disease
- Endocarditis
- Increased cardiac output states
- Increased intracranial pressure
- Patent ductus arteriosus
- Murmmur through systole and diastole
- Bounding impulses
- Sinus Bradycardia
- Systemic AV Fistula
- Thyrotoxicosis
- sympoms include
- nervousness
- sweating
- heat intolerance
- tachycardia
- weight loss
- Potential thyroid nodule
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
- will indicate aortic dissection and aortic knob enlargement
- shows 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