An abnormally large (“wide”) pulse pressure is one that is greater than 50% of the systolic blood pressure.
Hence, in a patient with a systolic of 140 mmHg and a diastolic of 60, the pulse pressure is 80. The most
common cause is a hyperkinetic heart syndrome, a high output state characterized by increased stroke volume and low peripheral vascular resistance. This is seen in various conditions, including:
Aortic regurgitation
Patent ductus arteriosus (PDA)
Exercise
Anxiety
Fever
Anemia
Arteriovenous fistulas
Beriberi
Paget’s disease
Cirrhosis
Pregnancy
Thyrotoxicosis
Severe exfoliative dermatitis
Many of these are characterized by arteriovenous (A-V) fistula(s) that may be large and single (as in
PDA), or small and multiple. The latter are seen in Paget’s disease (the fistulas are in the bone); exfoliative
dermatitis (the fistulas are in the skin); cirrhosis (the fistulas are both hepatic and extrahepatic); and
pregnancy (the entire placenta functions as a big A-V fistula). Shunt from fistulas is then responsible for the
high output and hyperdynamic state.
Hence, in a patient with a systolic of 140 mmHg and a diastolic of 60, the pulse pressure is 80. The most
common cause is a hyperkinetic heart syndrome, a high output state characterized by increased stroke volume and low peripheral vascular resistance. This is seen in various conditions, including:
Aortic regurgitation
Patent ductus arteriosus (PDA)
Exercise
Anxiety
Fever
Anemia
Arteriovenous fistulas
Beriberi
Paget’s disease
Cirrhosis
Pregnancy
Thyrotoxicosis
Severe exfoliative dermatitis
Many of these are characterized by arteriovenous (A-V) fistula(s) that may be large and single (as in
PDA), or small and multiple. The latter are seen in Paget’s disease (the fistulas are in the bone); exfoliative
dermatitis (the fistulas are in the skin); cirrhosis (the fistulas are both hepatic and extrahepatic); and
pregnancy (the entire placenta functions as a big A-V fistula). Shunt from fistulas is then responsible for the
high output and hyperdynamic state.