Wide pulse pressure

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.

Differential Diagnosis of Causes of
In alphabetical order


 * Aortic Dissection
 * Atherosclerosis
 * Due to the hardening of arteries with age, there is an increased systolic blood pressure resulting in a higher pulse pressure.


 * Aortic regurgitation
 * Complete heart block
 * Endocarditis
 * Increased cardiac output states
 * Anemia
 * Anxiety
 * Fever
 * Pregnancy


 * Increased intracranial pressure
 * Patent ductus arteriosus
 * Murmmur through systole and diastole
 * Bounding impulses


 * Sinus Bradycardia
 * Systemic AV Fistula
 * Thyrotoxicosis

Heart
Chronic Aortic Regurgitation
 * Diastolic murmur
 * Corrigan pulse
 * Rapid rise and fall


 * Hill's sign
 * Systolic BP of lower limbs >20mmHg than Systolic BP in arms

Other
Chronic Aortic Regurgitation
 * de Musset's sign
 * 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 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

Acute Pharmacotherapies

 * Emergency blood cultures and IV antibiotic for endocarditis

Chronic Pharmacotherapies
Hyperthyroidism Chronic aortic regurgitation
 * Beta-blockers
 * PTU
 * diuretics
 * pressors
 * vasodilators

Indications for Surgery
Aortic dissection
 * Emergency surgery

Chronic aortic regurgitation
 * Aortic valve replacement
 * Commonly in patients with low EF

''Hyperthyroidism
 * thyroidectomy