Wide pulse pressure
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
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
- Abdominal aortic aneurysm
- Anemia
- Anesthesia
- Anxiety
- Aortic dissection
- Aortic insufficiency
- Aortic regurgitation
- Arteriosclerosis
- Arteriovenous fistula
- Artificial pacemaker
- Atherosclerosis
- Atrial fibrillation
- Benzodiazepine withdrawal syndrome
- Cardiac arrest
- Cocaine
- Complete heart block
- Dengue fever
- Diabetes mellitus
- Elderly
- Endocarditis
- Ethylene
- Extreme bradycardia
- Fever
- Genetic
- Graves disease
- Growth hormone
- Heart murmur
- High output cardiac failure
- Hyperkinetic heart syndrome
- Hypertension
- Infective endocarditis
- Isolated systolic hypertension
- Laser ablation
- Maprotiline
- Mechanical ventilation
- Mitral valve prolapse
- Monckeberg's arteriosclerosis
- Nicotine
- Oxybutynin
- Oxygen therapy
- Patent ductus arteriosus
- Phenelzine
- Polycystic ovary syndrome
- Pregnancy
- Pulmonic regurgitation
- Pyrexia
- Raised intracranial pressure
- Sinus bradycardia
- ST elevation myocardial infarction
- Stroke
- Subarachnoid hemorrhage
- Supraventricular tachycardia
- Third degree AV block
- Thyrotoxicosis
- Vasodilators
- Waterhammer pulse
- 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