Widened Pulse Pressure - Differential Diagnosis and Pathophysiology Pulse pressure is the difference between the systolic blood pressure and the diastolic blood pressure. Pulse Pressure = Systolic Blood Pressure - Diastolic Blood Pressure “Widened” PP is defined as >100 mm Hg although PP should always be considered in the context of the patient’s absolute SBP and DBP. Pulse Pressure = Stroke Volume / Arterial Aompliance Physiologic Causes: • Advanced age-arteriosclerosis (less compliant arteries) • Pregnancy • Well-conditioned athletes Pathologic Causes: • Valvular disorders: - Aortic regurgitation - Aortic sclerosis (both heart valve conditions) • Severe iron deficiency anemia (reduced blood viscosity) • Hyperdynamic circulation/High output heart failure: - Hyperthyroidism/Thyrotoxicosis - Wet Beriberi - Obesity - Cirrhosis (Hyperdynamic circulation) - Erythroderma - Myeloproliferative disorders - Chronic pulmonary diseases • Arteriovenous fistula - Such as patent ductus arteriosus or peripheral arteriovenous malformations • Sympathetic overdrive • Elevated Intracranial Pressure • Vasoplegia • Sepsis Complications of Widened Pulse Pressure: • Pulse pressure - associated with an increased risk of developing atrial fibrillation • Mitchell et al. showed that patients with a pulse pressure greater than 61 mmHg developed atrial fibrillation at a rate of 23.3% • Wide PP and systolic hypertension had a significantly positive association with coronary heart disease • Increased risk for stroke • Worse outcomes in CKD Differential Diagnoses: • Acute Coronary Syndrome • Blunt Abdominal Trauma • Heart Failure • Infective Endocarditis • Mitral Regurgitation • Mitral Stenosis • Myocardial Infarction • Pulmonary Regurgitation (Pulmonic Regurgitation) • Tricuspid Stenosis #Widened #Pulse #Pressure #Differential #Diagnosis #Pathophysiology #causes #cardiology
