Wide Pulse Pressure (Jump Pulse)

Specialty: Cardiovascular.

• celler pulse
• increased differential pressure
• peripheral hyperdynamic pulse

Why it occurs

• Chronic severe aortic valve insufficiency
• Large patent ductus arteriosus
• Large volume systemic arteriovenous fistula
• Thyrotoxicosis or thyrotoxic crisis
• Severe chronic anemia (hemoglobin <7 g/dL)
• Extreme senile aortic sclerosis or stiffness (common cause in elderly people with isolated systolic hypertension)

Initial workup

Automated and repeated recording of blood pressure to quantify the real blood pressure gradient; Transthoracic Doppler echocardiogram to rigorously evaluate the aortic valve, measure transvalvular gradient, determine regurgitation volume, evaluate left ventricular end-systolic and end-diastolic diameters and volumes, and measure ejection fraction; Laboratory profile including complete blood count (rule out severe anemia), thyroid function tests (TSH, free T4), and serum electrolytes.

Standard management

• Ramipril — ACEI indicated in chronic aortic insufficiency to induce peripheral vasodilation, reduce systolic pressure and reduce regurgitant volume; 5 to 10 mg once daily orally, monitoring serum creatinine
• Amlodipine — dihydropyridine calcium antagonist to induce systemic arterial vasodilation and control borderline diastolic blood pressure in the presence of senile aortic stiffness; 5 to 10 mg per day orally
• Furosemide — loop diuretic useful if pulmonary congestive signs or peripheral edema are associated; 20 to 40 mg orally per day
• Thiamine (indicated if the confirmed etiology is hyperdynamic heart failure due to vitamin B1 deficiency; 100 mg intravenously per day).