STUDY - Technical - New Dacian's Medicine
Pulse
pressure (abnormal) (Classical / Allopathic Medicine)
Pulse
pressure - the difference between systolic and diastolic
blood pressures - is measured by sphygmomanometry or
intra-arterial monitoring. Normally, systolic pressure
exceeds diastolic pressure by about 40 mm Hg. Narrowed
pressure - a difference of less than 30 mm Hg - occurs
when peripheral vascular resistance increases, cardiac
output declines, or intravascular volume markedly
decreases.
In
conditions that cause mechanical obstruction (such as
aortic stenosis), the pulse pressure is directly related
to the severity of the underlying condition. Usually, a
late sign or narrowed pulse pressure alone doesn't signal
an emergency, even though it commonly occurs with shock
and other life-threatening disorders.
Widened
pulse pressure - a difference of more than 50 mm Hg -
commonly occurs as a physiologic response to fever, hot
weather, exercise, anxiety, anemia, or pregnancy. It can
also result from a neurologic disorder - especially
life-threatening increased intracranial pressure (ICP) -
or from a cardiovascular disorder such as aortic
insufficiency, which causes backflow of blood into the
heart with each contraction. Widened pulse pressure can be
easily identified by monitoring arterial blood pressure
and is commonly detected during routine sphygmomanometric
recordings.
HISTORY:
Review the patient's medical history for chest pain, dizziness, syncope, shortness of breath, and weakness. Also, review the patient's past blood pressure readings, if possible.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs.
Review the patient's medical history for chest pain, dizziness, syncope, shortness of breath, and weakness. Also, review the patient's past blood pressure readings, if possible.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs.
PHYSICAL
ASSESSMENT:
If you detect a narrowed pulse pressure, perform the following:
Check for signs of heart failure, such as hypotension, tachycardia, dyspnea, jugular vein distention, pulmonary crackles, and decreased urine output.
Check for changes in skin temperature or color, the strength of peripheral pulses, and level of consciousness.
Auscultate the heart for murmurs.
If you detect a widened pulse pressure, perform the following:
Check for signs of increased ICP. Perform a thorough neurologic examination, which will serve as a baseline for subsequent changes.
Check cranial nerve function - especially in cranial nerves III, IV, and VI.
Assess pupillary reactions, reflexes, and muscle tone.
Check for edema, and auscultate for murmurs.
If you detect a narrowed pulse pressure, perform the following:
Check for signs of heart failure, such as hypotension, tachycardia, dyspnea, jugular vein distention, pulmonary crackles, and decreased urine output.
Check for changes in skin temperature or color, the strength of peripheral pulses, and level of consciousness.
Auscultate the heart for murmurs.
If you detect a widened pulse pressure, perform the following:
Check for signs of increased ICP. Perform a thorough neurologic examination, which will serve as a baseline for subsequent changes.
Check cranial nerve function - especially in cranial nerves III, IV, and VI.
Assess pupillary reactions, reflexes, and muscle tone.
Check for edema, and auscultate for murmurs.
SPECIAL
CONSIDERATIONS:
Keep in mind that increasing ICP is commonly signaled by subtle changes in a patient's condition, rather than the abrupt development of any one sign or symptom.
Keep in mind that increasing ICP is commonly signaled by subtle changes in a patient's condition, rather than the abrupt development of any one sign or symptom.
PEDIATRIC
POINTERS:
In children, narrowed pulse pressure can result from congenital aortic stenosis or from a disorder that affects adults.
Increased ICP causes widened pulse pressure in children. Patent ductus arteriosus (PDA) can also cause widened pulse pressure, but this sign may not be evident at birth. The older child with PDA experiences exertional dyspnea, with pulse pressure that widens even further on exertion.
In children, narrowed pulse pressure can result from congenital aortic stenosis or from a disorder that affects adults.
Increased ICP causes widened pulse pressure in children. Patent ductus arteriosus (PDA) can also cause widened pulse pressure, but this sign may not be evident at birth. The older child with PDA experiences exertional dyspnea, with pulse pressure that widens even further on exertion.
AGING
ISSUES:
Recently, widened pulse pressure has been found to be a more powerful predictor of cardiovascular events in elderly patients than either increased systolic or diastolic blood pressure.
Recently, widened pulse pressure has been found to be a more powerful predictor of cardiovascular events in elderly patients than either increased systolic or diastolic blood pressure.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include echocardiography and electrocardiography.
Instruct the patient on what to expect from diagnostic testing, which may include echocardiography and electrocardiography.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.