pulse pressure

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Specializes in critical care,flight nursing.

I know a few study that has been talking about pulse pressure as an effective marker for cardiovascular disease and now stroke. I heard also widening pulse pressure is a symtoms of cardiac tamponade. I was wondering if there any others clinical sigificance to narrowing or widening or the pulse pressure. Any good, study or article??

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do you have access to the CINAHL database, they seem to have a lot of full text articles on pulse pressure.

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widened pulse pressure in the neonate can indicate a patent ductus arteriosis..... thats about all I know!

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Specializes in ED, Critical Care, Street Outreach.

I think a sign of cardiac tamponade is narrowing pulse pressure. [Kowalak, P. & Hughes, A. (2002). Handbook of signs & symptoms - 2nd ed. Lippincott Williams & Wilkins. New York.] But I've never seen it clinically.

Just google "widening pulse pressure" and numerous articles are returned. Not to hijack the thread, but I'm new to Alberta, do you like Calgary?

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true, if you put pressure around the outside of the heart then the heart muscle cant expand to allow for diastasis.

Is that right as an explanation?

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Specializes in ED, Critical Care, Street Outreach.

this explains it well: http://www.emedicine.com/med/topic283.htm

i thought this was a great summary:

reddy et al describe 3 phases of hemodynamic changes in tamponade.

  • phase i: the accumulation of pericardial fluid causes increased stiffness of the ventricle, requiring a higher filling pressure. during this phase, the left and right ventricular filling pressures are higher than the intrapericardial pressure.
  • phase ii: with further fluid accumulation, the pericardial pressure increases above the ventricular filling pressure, resulting in reduced cardiac output.
  • phase iii: a further decrease in cardiac output occurs, which is due to equilibration of pericardial and left ventricular (lv) filling pressures.

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Specializes in Neuro ICU and Med Surg.

Widening pulse pressure can also signify increased ICP. Cushing's Triad consists of widening pulse pressure, irregular respirations, and bradycardia.

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Specializes in Flight, ER, Transport, ICU/Critical Care.

First, What is PULSE PRESSURE?

The measure between systole and diastole.

Any narrowing or widening should be considered in the presence of patient assessment, signs/symptoms and co-morbid conditions.

There are lots "numbers" and "parameters" in clinical practice, but all are only meaningful in the context of WHAT DOES THIS MEAN FOR MY PATIENT!

Tamponade exists with a NARROW pressure. ;)

Other tamponade indicators: JVD, SOA, Low EKG gain, muffled heart sounds.

PRACTICE SAFE!

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Specializes in critical care,flight nursing.

well coming from a very alive city like Montreal, I found Calgary is still drowsy and have some crust in the coner of the eyes!!!:lol2: It need a few more cup of coffee, but so close to the mountains... I can you go wrong!!:welcome:

I think a sign of cardiac tamponade is narrowing pulse pressure. [Kowalak, P. & Hughes, A. (2002). Handbook of signs & symptoms - 2nd ed. Lippincott Williams & Wilkins. New York.] But I've never seen it clinically.

Just google "widening pulse pressure" and numerous articles are returned. Not to hijack the thread, but I'm new to Alberta, do you like Calgary?

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Specializes in Geriatrics, Med-Surg..

Hey phiposurde, I too have family in Montreal and have spent lots of time there. The night life is the best and it is such an alive city. Love it but don't live there. I will be starting my BSN in Sept. 07. I see that you have been in critical care for some time. Do you still like it and did you start there?

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Specializes in critical care,flight nursing.

Hey phiposurde, I too have family in Montreal and have spent lots of time there. The night life is the best and it is such an alive city. Love it but don't live there. I will be starting my BSN in Sept. 07. I see that you have been in critical care for some time. Do you still like it and did you start there?

&&& From nusring school to now I knew I wansted to be in critical care. Some of my teacher were tired to hear me talk about it!!!8) By the time i was in 2nd year I did my acls and was missing day of school to go to conference!!loL

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hello guys>>>

Usually, the resting pulse pressure in healthy adults, sitting position, is about 40 mmHg. The pulse pressure increases with exercise due to increased stroke volume, healthy values being up to pulse pressures of about 100 mmHg, simultaneously as total peripheral resistance drops during exercise. In healthy individuals the pulse pressure will typically return to normal within about 10 minutes.

For most individuals, during exercise, the systolic pressure progressively increases while the diastolic remains about the same. In some very aerobically athletic individuals, the diastolic will progressively fall as the systolic increases. This behavior facilitates a much greater increase in stroke volume and cardiac output at a lower mean arterial pressure and enables much greater aerobic capacity and physical performance. The diastolic drop reflects a much greater fall in total peripheral resistance of the muscle arterioles in response to the exercise (a greater proportion of red versus white muscle tissue).

Low values

If the usual resting pulse pressure is measured as less than 40 mmHg, the most common reason is an error of measurement. If the pulse pressure is genuinely low, e.g. 25 mmHg or less, the cause may be low stroke volume, as in Congestive Heart Failure and/or shock, a serious issue. This interpretation is reinforced if the resting heart rate is relatively rapid, e.g. 100-120 (in normal sinus rhythm), reflecting increased sympathetic nervous system activity.

High values

If the usual resting pulse pressure is consistently greater than 40 mmHg, e.g. 60 or 80 mmHg, the most likely basis is stiffness of the major arteries, aortic regurgitation (a leak in the aortic valve), an extra path for the blood to travel from the arteries to the veins, hyperthyroidism or some combination. (A chronically increased stroke volume is also a technical possibility, but very rare in practice.) Some drugs for hypertension have the side effect of increasing resting pulse pressure irreversibly. A high resting pulse pressure is harmful and tends to accelerate the normal ageing of body organs, particularly the heart, the brain and kidneys. A high pulse pressure combined with bradycardia is associated with increased intracranial pressure and should be reported to a physician immediately.

so what is the relaition to the HEART DISEASES??

Recent work suggests that a high pulse pressure is an important risk factor for heart disease. A meta-analysis in 2000, which combined the results of several studies of 8,000 elderly patients in all, found that a 10 mm Hg increase in pulse pressure increased the risk of major cardiovascular complications and mortality by nearly 20%[2]. The authors suggest that this helps to explain the apparent increase in risk sometimes associated with low diastolic pressure, and warn that some medications for high blood pressure may actually increase the pulse pressure and the risk of heart disease

Have a good day. :)

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