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Pulse pressure is calculated as the difference between the systolic blood pressure and the diastolic blood pressure. [3] [4]The systemic pulse pressure is approximately proportional to stroke volume, or the amount of blood ejected from the left ventricle during systole (pump action) and inversely proportional to the compliance (similar to elasticity) of the aorta.
Aortic regurgitation causes both volume overload (elevated preload) and pressure overload (elevated afterload) of the heart. [14] The volume overload, due to elevated pulse pressure and the systemic effects of neuroendocrine hormones causes left ventricular hypertrophy (LVH). [9] There is both concentric hypertrophy and eccentric hypertrophy in AI.
Hyperdynamic circulation is abnormally increased circulatory volume. Systemic vasodilation and the associated decrease in peripheral vascular resistance results in decreased pulmonary capillary wedge pressure and decreased blood pressure, presenting usually with a collapsing pulse, but sometimes a bounding pulse.
One can hear it at the left lower sternal border. One may also hear it at the right lower sternal border (when associated with a dilated aorta). Other possible exam findings are bounding carotid and peripheral pulses. These are also known as Corrigan's pulse or Watson's water hammer pulse. Another possible finding is a widened pulse pressure.
If the systolic blood pressure is elevated (>140) with a normal (<90) diastolic blood pressure (DBP), it is called isolated systolic hypertension. [2] Eighty percent of people with systolic hypertension are over the age of 65 years old. [3] Isolated systolic hypertension is a specific type of widened (or high) pulse pressure.
De Musset's sign is a type of rhythmic bobbing of the head in synchrony with the beating of the heart, seen in severe aortic regurgitation. [1]This sign occurs as a result of blood from the aorta regurgitating into the left ventricle due to a defect in the aortic valve.
In the heart, increased arterial stiffness, increased systolic blood pressure, and widened pulse pressures, all resulting from chronic hypertension, can cause significant damage. Coronary perfusion pressures are decreased by these factors, which also increase myocardial oxygen consumption, possibly leading to left ventricular hypertrophy .
Arterial stiffness may also affect the time at which pulse wave reflections return to the heart. As the pulse wave travels through the circulation it undergoes reflection at sites where the transmission properties of the arterial tree change (i.e. sites of impedance mismatch). These reflected waves propagate backward towards the heart.