Pulses (Pulsus)
What is a normal Pulse Pressure?
- A normal Pulse Pressure is 40-60 mmHg
Wide Pulse Pressure
- Increased difference between the systolic and diastolic blood
pressure of more than 60 mmHg
- Differential
- Increased arterial stiffness (age, smoking, etc.)
- High output states (hyperdynamic circulation)
- Aortic regurgitation
- Hyperthyroidism
- Anemia
- Beriberi (Vitamin B1 deficiency)
- Medications
Narrow pulse pressure
- Decreased difference between systolic and diastolic blood
pressures of less than 40 mmHg
- Differential
- Low blood volume
- Dehydration
- Blood loss
- Shock (increased peripheral vascular resistance)
- Heart failure
- Aortic stenosis
- Medications
- Beta-blockers
- Calcium channel blockers
Pulsus paradoxus
- SBP drops more than 10 mmHg during inspiration
- SBP normally drops during inspiration, but not normally
greater than 10 mmHg
- How to measure
- Inflate BP cuff until Korotkoff sounds are gone
- Slowly deflate BP cuff until Korotkoff sounds are heard only
during expiration - SBP1
- Slowly deflate BP cuff until Korotkoff sounds are heard
during expiration and inspiration - SBP2
- SBP1 - SBP2 = ?
- Differential
- Cardiac tamponade
- Asthma/COPD (Obstructive lung diseases)
- Massive Pulmonary Embolism
- Tension pneumothorax
- Pericarditis
- Pleural effusions
- Hypovolemia
- Pulsus Paradoxus may be masked by
- Aortic regurgitation
- Atrial septal defect
- Hypotension