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]

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.

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Aortic dissection
• Atrial fibrillation
• Dengue fever
• Endocarditis
• ST elevation myocardial infarction

• Anemia
• Anxiety
• Aortic dissection
• Aortic regurgitation
• Arteriovenous fistula
• Atherosclerosis
• Complete heart block
• Endocarditis
• Fever
• Isolated systolic hypertension
• Patent ductus arteriosus
• Raised intracranial pressure
• Thyrotoxicosis

Cardiovascular	Abdominal aortic aneurysm, aortic dissection, aortic insufficiency, aortic regurgitation, arteriosclerosis, arteriovenous fistula, artificial pacemaker, atherosclerosis, atrial fibrillation, cardiac arrest, complete heart block, endocarditis, extreme bradycardia, heart murmur, high output cardiac failure, hyperkinetic heart syndrome, hypertension, infective endocarditis, isolated systolic hypertension, mitral valve prolapse, Monckeberg’s arteriosclerosis, patent ductus arteriosus, pulmonic regurgitation, sinus bradycardia, ST elevation myocardial infarction, stroke, supraventricular tachycardia, third degree AV block, waterhammer pulse, wet beriberi
Chemical/Poisoning	Ethylene
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Benzodiazepine withdrawal syndrome, cocaine, maprotiline, nicotine, oxybutynin, oxygen therapy, phenelzine, vasodilators
Ear Nose Throat	No underlying causes
Endocrine	Diabetes mellitus, Graves disease, growth hormone, polycystic ovary syndrome, thyrotoxicosis
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	Genetic
Hematologic	Anemia
Iatrogenic	Anesthesia, laser ablation, mechanical ventilation
Infectious Disease	Dengue fever, infective endocarditis
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	Raised intracranial pressure, stroke, subarachnoid hemorrhage
Nutritional/Metabolic	Wet beriberi
Obstetric/Gynecologic	Polycystic ovary syndrome, pregnancy
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	Anxiety
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	Elderly, fever, mechanical ventilation, pyrexia

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

Chronic Aortic Regurgitation

• de Musset’s sign

• head bobs back and forth with each heartbeat

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

• May demonstrate aortic dissection if there is aortic knob enlargement and widened mediastinum

• CT can indicate aortic dissection
• MRI can also be used to diagnose aortic dissection

• Better than Aortography
• Transesophageal echocardiography measures aortic regurgitation

• detects two additional lumen for diagnosis of aortic dissection

• If there is a suspicion of atherosclerosis;

• CAD risk stratification measurement
• Cholesterol screening
• Stress test
• Cardiac catheterization

• Treat underlying causes

• Anemia
• Chronic disease
• Fever
• Hypothyroidism
• Regulate cranial pressure

• Emergency blood cultures and IV antibiotic for endocarditis

Hyperthyroidism

• Beta-blockers
• PTU

Chronic aortic regurgitation

• Diuretics
• Pressors
• Vasodilators

Aortic dissection

• Emergency surgery

Chronic aortic regurgitation

• Aortic valve replacement
• Commonly in patients with low EF

Hyperthyroidism

• Thyroidectomy

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