After an otherwise uneventful, induction of anaesthesia with propofol, fentanyl and rocuronium, he was maintained on sevoflurane anaesthesia. An arterial line was placed for invasive BP monitoring. There were no difficulties in oxygenation or ventilation. At the end of the case, the trachea was extubated and patient transported to the Intensive Care Unit ICU for postoperative monitoring. He was administered a ml bolus of crystalloids on arrival without a change of diastolic pressure, after which he was placed on maintenance crystalloid fluid only.
Philips IntelliVue MP90 : A sample of the patient's vital signs on arrival in the Intensive Care Unit post-operatively showing persistently widened pulse pressure and very low diastolic blood pressure.
In adults, a wide pulse pressure may be the result of cardiovascular pathology, for example, severe aortic regurgitation or severe atherosclerotic disease. A search of the existing literature revealed that widened pulse pressure is mainly associated with atherosclerotic disease and stiffening of arterioles, resulting in an amplification of the pressure transmitted along peripheral vessels[ 1 ] and may not accurately reflect central pressures. An increased pulse pressure is also associated with an increased risk of heart failure,[ 3 ] increased risk of stroke after cardiac surgery,[ 4 ] and an increased risk of fatal and non-fatal adverse cerebral and cardiac outcomes in patients undergoing cardiac surgery.
We propose that, based on physiologic mechanisms, the potential causes of a wide pulse pressure in surgical patients include: 1 Severe intravascular hypovolaemia or vasoplegia that should respond to volume repletion or discontinuation of anaesthetic agents. Sepsis would be accompanied by other signs of an inflammatory syndrome and a possibly known infectious source.
Anaphylaxis would often be associated with clinical signs and can be confirmed by raised tryptase levels. In the present case, the aetiology of an extremely low diastolic pressure and wide pulse pressure remains unclear.
The patient had mild aortic insufficiency on transthoracic echocardiogram, was normothermic, had no other evidence of, or causes to suspect ongoing sepsis or liver failure, and the DBP was not fluid-responsive. The significance of unexplained wide pulse pressure in our patient only resulted in increased attention by providers towards the arterial trace without any adverse consequence in the patient.
National Center for Biotechnology Information , U. Read on for more information about what your pulse pressure could tell you about your heart health. To measure your pulse pressure, your doctor will start by measuring your blood pressure.
This resulting number is your pulse pressure. This may be due to:. Having a wide pulse pressure also increases your risk of developing a condition called atrial fibrillation.
This occurs when the top portion your heart, called the atria, quivers instead of beating strongly. According to Harvard Health, someone with a wide pulse pressure is 23 percent likely to have atrial fibrillation.
This is compared with 6 percent for those whose pulse pressures are under 40 mm Hg. A wide pulse pressure may also be associated with coronary artery disease or heart attack. Over time, however, you might begin to notice:. A wide pulse pressure is usually a sign of an underlying problem, so treatments usually depend on the condition. However, most treatments involve lowering blood pressure, which can also lower a wide pulse pressure.
While you can often do this by making some lifestyle or dietary changes, your doctor might prescribe medication for more severe cases. In these cases, your doctor may prescribe medication. There are several types of medication for managing high blood pressure, including:.
Keep in mind that you may need additional treatment, including different medications, to get a wide pulse pressure under control, depending on the underlying cause. Wide pulse pressure is usually an indication that something is causing your heart to work less efficiently. Checking your blood pressure at home with a manual or automated device can help you monitor your health between doctor visits.
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What is pulse pressure? How important is pulse pressure to your overall health? Answer From Sheldon G. With Sheldon G. Thank you for Subscribing Our Housecall e-newsletter will keep you up-to-date on the latest health information. Please try again. Something went wrong on our side, please try again.
Show references Townsend RR. Increased pulse pressure. Accessed Jan. Cremer A, et al. Journal of the American Heart Association. Williams B, et al. Journal of Hypertension. Fuster V, et al. Epidemiology of hypertension. In: Hurst's the Heart.
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