Wide Pulse Pressure Differential Diagnosis: Corrigan Pulse Experienced!

I've never seen such a wide pulse pressure.  A widened pulse pressure is the difference between your systolic (top number) and your diastolic (bottom number) blood pressures.  A normal pulse pressure is 40mmHg for a normal blood pressure of 120/80. I once took care of a gentleman with an unbelievably  wide pulse pressure of 263mmHg due to a blood pressure of 295/32.  That's incredible by any stretch of the imagination.  He responded well to one dose of 20mg of labetolol.

What is the differential diagnosis for a widened pulse pressure?  It is classically  found in patients with acute aortic regurgitation (insufficiency), or the abnormal retrograde flow of blood into the left ventricle during diastole. The widened pulse pressure is due to elevated stroke volume during systole  and the decreased diastolic pressure of the aorta because of the incompetent valve.  It can also be found in patients with severely elevated intracranial pressures although I have not reviewed the physiology of that mechanism.

My patient had distal ankle pulses that felt like bounding lead pipes.  I have never experienced such a clinical finding and I will never forget it.  It's shocking to feel it first hand.   It's called the Corrigan pulse, or "water-hammer" pulse.  Can you name the other classic named findings of  the widened pulse pressure of AI?

Generally patients with acute aortic insufficiency require surgery.  Vasodilators can be used in the long term management of chronic AI.  In my patient's case, a diagnosis of aortic endocarditis (infected heart valve) was made.    It's amazing what the human body can endure and how quickly a diagnosis  can turn your life upside down.  Go here for other crazy medical experiences.



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